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With sexual violence prevention programs gaining traction in secondary schools, students’ attitudes toward sexual violence have begun to be measured more frequently. While these attitudes are measu...

This study assesses HIV provider views on the value of a checklist designed to assess patients’ preconception care (PCC) needs and guide implementation of PCC. Ninety-two HIV providers in seven U.S. cities provided perspectives via an in-depth phone interview regarding a checklist to facilitate communication and referrals for PCC. A sub-sample of 27 providers shared feedback on a checklist designed for this purpose. Interview audio files were transcribed and uploaded to a web-based program supporting coding and analysis of qualitative data. Content analysis was utilized to identify key themes within the larger, a priori themes of interest. Feedback regarding the checklist was analyzed using a grounded theory approach to examine patterns and emergent themes across transcripts. Providers averaged 11.5 years of HIV treatment experience; over 80 percent were physicians (MD) or nurse practitioners (NP) and 76 percent were HIV/infectious disease specialists. The majority of providers were female (70%) and Caucasian (72%). Checklist benefits identified included standardization of care, assisting new/inexperienced providers, educational resource for patients, and aid in normalizing childbearing. Concerns included over-protocolizing care, interfering with patient-provider communication, or requiring providers address non-priority issues during visits. Providers suggested checklists be simple, incorporated into the electronic medical record, and accompanied with appropriate referral systems. Findings support a need for a checklist tool to assist in conversations about reproductive intentions/desires. Additional referral or innovative consultative services will be needed as more persons living with HIV/AIDS are engaged on the topic of childbearing.

Objectives: The aim of the current study was to examine the relations among mindfulness, posttraumatic stress disorder (PTSD) symptom severity, and stressful life events (SLEs) in African-American urban adolescents. Another aim was to examine mindfulness as a moderator of the relation between SLEs and PTSD symptom severity in this population. Method: Eighty-eight African-American high school students from a low-income urban community completed measures of demographics, PTSD symptom severity, SLEs, and mindfulness. Results: Mindfulness was significantly negatively related to PTSD symptom severity, r(86) = −.70, p

This article presents a qualitative research approach to exploring attorney–client communication in an urban public defense system. The study drew upon procedural justice theory (PJT), which emphasizes relationships between satisfaction with system procedures and compliance with system demands. Interpretive analysis of interview data from 22 public defense clients revealed four major themes. PJT accounted well for three themes of communication time, type, and content, highlighting relationships between prompt, iterative, complete communication, and client satisfaction. The fourth theme involved clients exercising agency, often due to dissatisfaction with attorney communication. This theme was better accommodated by legal consciousness theory, which emphasizes that diverse experiences with law include manipulation and opposition alongside compliance. Implications for policy and research are discussed.

The HIV Infant Tracking System (HITSystem) is a web-based intervention linking providers of early infant diagnosis, laboratory technicians, and mothers and infants to improve outcomes for HIV-exposed infants. We aimed to evaluate the efficacy of the HITSystem on key outcomes of early infant diagnosis.We did a cluster-randomised trial at six hospitals in Kenya, which were matched on geographic region, resource level, and volume of patients (high, medium, and low). We randomly allocated hospitals within a matched pair to either the HITSystem (intervention; n=3) or standard of care (control; n=3). A random number generator was used to assign clusters. Investigators were unaware of the randomisation process. Eligible participants were mothers aged 18 years or older with an infant younger than 24 weeks presenting for their first early infant diagnosis appointment. The primary outcome was complete early infant diagnosis retention, which was defined as receipt of all indicated age-specific interventions until 18 months post partum (for HIV-negative infants) or antiretroviral therapy initiation (for HIV-positive infants). Analysis was per protocol in all randomised pairs judged eligible, excluding infant deaths and those who moved or were transferred to another health facility. Modified intention-to-treat sensitivity analyses judged all infant deaths and transfers as incomplete early infant diagnosis retention. Separate multivariable logistic regression analyses were done with intervention group, hospital volume, and significant covariates as fixed effects. This trial is registered with ClinicalTrials.gov, number NCT02072603; the trial has been completed.Between Feb 16, 2014, and Dec 31, 2015, 895 mother-infant pairs were enrolled. Of these, 87 were judged ineligible for analysis, 26 infants died, and 92 pairs moved or were transferred to another health facility. Thus, data from 690 mother-infant pairs were analysed, of whom 392 were allocated to the HITSystem and 298 to standard of care. Mother-infant pairs were followed up to Sept 30, 2017. Infants diagnosed as HIV-positive were followed up for a median of 2·1 months (IQR 1·6-4·8) and HIV-negative infants were followed up for a median of 17·0 months (IQR 16·6-17·6). Infants enrolled in the HITSystem were significantly more likely to receive complete early infant diagnosis services compared with those assigned standard of care (334 of 392 [85%] vs 180 of 298 [60%]; adjusted odds ratio [OR] 3·7, 95% CI 2·5-5·5; p0·0001). No intervention effect was recorded at high-volume hospitals, but strong effects were seen at medium-volume and low-volume hospitals. Modified intention-to-treat analyses for complete early infant diagnosis were also significant (334 of 474 [70%] vs 180 of 334 [54%]; adjusted OR 2·0, 95% CI 1·4-2·7; p0·0001). No adverse events related to study participation were reported.The HITSystem intervention is effective and feasible to implement in low-resource settings. The HITSystem algorithms have been modified to include HIV testing at birth, and an adapted HITSystem 2.0 version is supporting HIV-positive pregnant women to prevent perinatal transmission and optimise maternal and infant outcomes.National Institute of Child Health and Human Development.

We assessed the preliminary impact of the adapted HIV Infant Tracking System (HITSystem v2.0) intervention on prevention of mother-to-child transmission (PMTCT) outcomes using a matched cluster randomized design in two Kenyan government hospitals. Between November 2017 and June 2019, n = 157 pregnant women with HIV were enrolled and followed from their first PMTCT appointment until 12-weeks postpartum. Data from 135 women were analyzed (HITSystem 2.0: n = 53, standard of care (SOC): n = 82), excluding eight deaths, eight pregnancy losses, and six transfers/moves. The primary outcome, complete PMTCT retention, is an aggregate measure of attendance at all scheduled antenatal appointments, hospital-based delivery, and infant HIV-testing before 7-weeks postnatal. HITSystem 2.0 participants were more likely to receive complete PMTCT services compared to SOC (56.6% vs. 17.1% p

This paper offers the first known interdisciplinary, community-based participatory research study to focus directly on two questions that have drawn increased attention in the wake of global protests over racialized police violence: 1) what is the definition of safety?; and 2) how can safety be made accessible to all? The study is part of a larger project that was co-designed by community members and academic researchers. The project aimed to strengthen local justice reform efforts by adding new data literacy skills to existing community organizing capacity among Black residents of the Cincinnati, Ohio metropolitan area. Community-led roundtable discussions offered community members (n=12) an opportunity to answer the two research questions. Exploratory qualitative analysis resulted in four emergent themes through which participants (1) defined safety primarily as freedom from harm and enjoyment of close, supportive relationships; (2) identified poverty and racism as key barriers to creating safety; (3) described complex, overlapping, and sometimes conflicting roles and responsibilities for creating safety; and (4) expressed strong ambivalence over whether and how police contribute to safety. Applying Bell’s legal estrangement theory, the team examined those themes for evidence of four modalities through which marginalized communities engage with criminal legal systems (subordination, consumption, resistance, and transformation). The data reflected minimal subordination and resistance, relatively high levels of consumption, and mixed perspectives on system transformation. Further implications for theory, policy, and future research are discussed.

This study assesses HIV provider views on the value of a checklist designed to assess patients' preconception care (PCC) needs and guide implementation of PCC.Ninety-two HIV providers in seven U.S. cities provided perspectives via an in-depth phone interview regarding a checklist to facilitate communication and referrals for PCC. A sub-sample of 27 providers shared feedback on a checklist designed for this purpose. Interview audio files were transcribed and uploaded to a web-based program supporting coding and analysis of qualitative data. Content analysis was utilized to identify key themes within the larger, a priori themes of interest. Feedback regarding the checklist was analyzed using a grounded theory approach to examine patterns and emergent themes across transcripts.Providers averaged 11.5 years of HIV treatment experience; over 80 percent were physicians (MD) or nurse practitioners (NP) and 76 percent were HIV/infectious disease specialists. The majority of providers were female (70%) and Caucasian (72%). Checklist benefits identified included standardization of care, assisting new/inexperienced providers, educational resource for patients, and aid in normalizing childbearing. Concerns included over-protocolizing care, interfering with patient-provider communication, or requiring providers address non-priority issues during visits. Providers suggested checklists be simple, incorporated into the electronic medical record, and accompanied with appropriate referral systems.Findings support a need for a checklist tool to assist in conversations about reproductive intentions/desires. Additional referral or innovative consultative services will be needed as more persons living with HIV/AIDS are engaged on the topic of childbearing.

The aim of the current study was to examine the relations among mindfulness, posttraumatic stress disorder (PTSD) symptom severity, and stressful life events (SLEs) in African-American urban adolescents. Another aim was to examine mindfulness as a moderator of the relation between SLEs and PTSD symptom severity in this population.Eighty-eight African-American high school students from a low-income urban community completed measures of demographics, PTSD symptom severity, SLEs, and mindfulness.Mindfulness was significantly negatively related to PTSD symptom severity, r(86) = -.70, p .001, 95% CI [-.58, -79], and SLEs were significantly positively related to PTSD symptom severity, r(86) = .29, p = .003, 95% CI [.09, .47]. Mindfulness was an independent predictor of PTSD symptom severity after accounting for SLEs, B = -1.16, t(84) = -9.06, p .001, 95% CI [-1.41, -0.90], and SLEs were an independent predictor of PTSD symptom severity after accounting for mindfulness, B = 0.49, t(84) = 2.92, p = .004, 95% CI [0.16, 0.82]. Mindfulness did not moderate the relation between SLEs and PTSD symptom severity, B = -.003, t(84) = -0.15, p = .89, 95% CI [-.04, .03].This study has implications for both mindfulness as a potential protective factor against PTSD symptom severity and SLEs as a potential risk factor for increased PTSD symptom severity in African-American urban adolescents.

The purpose of this study is to explore similarities and differences in physical activity levels for boys and girls in seven areas across two playgrounds. Two playgrounds in a mid-Atlantic state in the United States were purposefully selected based on their playground design and structure. The System for Observing Play and Leisure Activities in Youth was used to document children’s physical activity types, track children’s locations, and code activity type. Playground A had five different areas, and Playground B had three different areas. Across the two playgrounds, data were collected across 416 total 1-minute intervals (morning, afternoon, and evening), spanning 13 days (weekend and weekdays) over a three-month period. The implications of this work are detailed observations of children’s play equipment and activity choices may provide insight into optimal playground equipment design and layout for play and social interactions between peers; fixed contemporary play equipment and open play spaces should be considered when designing new community playgrounds, as they appear to be equally interesting to boys and girls; and girls’ attire on a community playground and more available play space may contribute to more active play in girls than what was found in studies investigating play patterns on school playgrounds.

A new generation of research, building upon developmental psychopathology (Luthar et al. 1997; Luthar et al. (Child Development, 71, 543-562, 2000)), provides evidence that individual differences in risk for behavioral health problems result from intrapersonal and environmental modulation of neurophysiologic and genetic substrates. This transdisciplinary model suggests that, in any given individual, the number of genetic variants implicated in high-risk behavior and the way in which they are assorted and ultimately suppressed or activated in the brain by experiential and contextual factors help to explain behavioral orientations. Implications are that behavioral health problems can be amplified or reduced based on characteristics of an individual and socio-contextual influences on those characteristics. This emerging research has extraordinary implications for the design of prevention programs that more precisely target the malleable mechanisms that underlie behavioral health problems and, hence, more effectively prevent behavioral problems and promote resilience. A detailed, theory-driven examination of all evidence-based interventions is called for to identify the active ingredients that specifically impact these underlying mechanisms. Such an approach will enhance the ability of preventive interventions to achieve effect sizes indicative of beneficial impacts for a greater number of recipients. This paper presents the significant implications of this collective knowledge base for the next generation of precision-based, prevention-focused personalized interventions.

The Ohio Network of Education Transformation (ONET) funded schools to implement different models of school reform including Advancement Via Individual Determination (AVID), the Asia Society's International Studies Schools Network (ISSN), New Tech, and Early College. This article introduces these four reform models and considers their implementation and impacts for two sites each. Findings from a two-year evaluation focus on overarching themes and lessons learned across reform models. Four subsequent articles present findings from each model in greater detail. Taken together, this set of articles provides an in-depth understanding of educational reform implementation for often understudied reform models.

This case study examined the implementation of the Advancement Via Individual Determination (AVID) model in two schools funded for three years (2011–2014) through the Ohio Network of Education Transformation. Interviews, observations, and artifacts were gathered for two high schools over two years (2013–2014 and 2014–2015). At one year post-funding, one school's implementation of the AVID model was persevering and the other had completely halted. Several challenges with implementing the AVID model emerged to help explain the schools’ experiences and to suggest lessons learned.

This case study examined the implementation of Asia Society's International Studies Schools Network (ISSN) model in two schools funded for three years (2011–2014) through the Ohio Network of Education Transformation. Documents, interviews, and observations were gathered over two years (2013–2015) for two schools. One year post-funding, the high school's implementation of the ISSN model was thriving and the middle school was struggling to maintain its implementation. Several dimensions emerged from the data analysis to help explain the differences between the schools’ ISSN implementation and to suggest lessons learned specific to the ISSN reform model.

This editorial introduces a special issue containing five articles that report on an evaluation of the implementation of four education transformation models within the state of Ohio. The first article presents an overview of the cross-model results, followed by four individual articles that each present a case study analysis of one of the four transformation models. The editorial highlights how this evaluation effort as a whole demonstrates the importance of rigorous evaluation approaches for examining the strategies and challenges involved in state-wide transformation evaluation efforts.

Background: Despite progress to expand access to HIV testing and treatment during pregnancy in Kenya, gaps still remain in prevention of mother-to-child transmission of HIV (PMTCT) services. This study addresses the need for effective and scalable interventions to support women throughout the continuum of care for PMTCT services in low-resource settings. Our research team has successfully implemented the HIV Infant Tracking System (HITSystem), a Web-based, system-level intervention to improve early infant diagnosis (EID) outcomes. Objective: This study will expand the scope of the HITSystem to address PMTCT services to bridge the gap between maternal and pediatric HIV services and improve outcomes. This paper describes the intervention development protocol to adapt and pilot an HITSystem version 2.0 to assess acceptability, feasibility, and preliminary PMTCT outcomes in Kenya. Methods: This is a 3-year intervention development study to adapt the current HITSystem intervention to support a range of PMTCT outcomes including appointment attendance, antiretroviral therapy (ART) adherence, hospital deliveries, and integration of maternal and pediatric HIV services in low-resource settings. The study will be conducted in 3 phases. Phase 1 will elicit feedback from intervention users (patients and providers) to guide development and refinement of the new PMTCT components and inform optimal implementation. In Phase 2, we will design and develop the HITSystem 2.0 features to support key PMTCT outcomes guided by clinical content experts and findings from Phase 1. Phase 3 will assess complete PMTCT retention (before, during, and after delivery) using a matched randomized pilot study design in 2 hospitals over 18 months. A total of N=108 HIV-positive pregnant women (n=54 per site) will be enrolled and followed from their first PMTCT appointment until infant HIV DNA Polymerase Chain Reaction testing at the target age of 6 weeks (

Objective: HIV status disclosure is typically encouraged because of its purported benefits. Unintended consequences of status disclosure to People Living with HIV/AIDS (PLHA) and their partners, however, rarely receive research attention. Understanding unintended consequences is essential to addressing the public health challenge of reducing HIV/AIDS incidence and re-infection. This study explores how status disclosure may impederather than facilitate-behavioral adherence. Methods: A semi-structured interviews with 20 HIV positive women (mean age=27.9 (SD=8.2); 70% romantically involved), we explored why or why not these women adhere to sexual behavioral recommendations to protect against reinfection and transmission to partners. Interviews were transcribed, independently coded, and thematically analyzed. Participants understood condom use and ART adherence benefits. This did not always translate into adherence. Stigma concerns and partner willingness to risk transmission and reinfection influenced oscillations in behavioral adherence. Results: We found evidence for the “HIV Status Disclosure Paradox,” which includes four types. HIV status nondisclosure was related to greater behavioral adherence by (1) promoting abstinence and/ or singlehood, or (2) motivating infected women to insist on consistent condom use. Disclosure was related to (3) male partners’ willingness to risk transmission or reinfection by insisting on unprotected sex and women’s relinquishment of responsibility after disclosure, or (4) selecting partners accepting of HIV status or weeding out unaccepting partners. Conclusion: These paradoxes coupled with suboptimal medical adherence suggest increased risk potential among PLHA and their partners. Disclosure counseling with patients and partners should incorporate information and messages to minimize unintended consequences that increase transmission or reinfection risk.

UNSTRUCTURED Background: Despite progress to expand access to HIV testing and treatment during pregnancy in Kenya, gaps still remain in prevention of mother-to-child transmission of HIV (PMTCT) services. This study addresses the need for effective and scalable interventions to support women throughout the continuum of care for PMTCT services in low resource settings. Our research team has successfully implemented the HIV Infant Tracking System (HITSystem), a web-based, system-level intervention to improve early infant diagnosis (EID) outcomes. This study will expand the scope of the HITSystem to address PMTCT services to bridge the gap between maternal and pediatric HIV services and improve outcomes. This paper describes the intervention development protocol to adapt and pilot a HITSystem version 2.0 to assess acceptability, feasibility, and preliminary PMTCT outcomes in Kenya. Methods/design: This is a three-year intervention development study to adapt the current HITSystem intervention to support a range of PMTCT outcomes including: retention in care, ART adherence, hospital deliveries, and integration of maternal and pediatric HIV services in low-resource settings. The study will be conducted in three phases. Phase 1 will elicit feedback from intervention users (patients and providers) to guide development and refinement of the new PMTCT components and inform optimal implementation. In Phase 2, we will design and develop the HITSystem 2.0 features to support key PMTCT outcomes guided by clinical content experts and findings from Phase 1. Phase 3 will assess complete PMTCT retention (before, during, and after delivery) using a matched randomized pilot study design in two hospitals over 18-months. A total of n=108 HIV+ pregnant women (n=54 per site) will be enrolled and followed from their first PMTCT appointment until infant HIV DNA PCR testing at the target age of 6 weeks (< 7 weeks) postnatal. Discussion: This protocol will extend, adapt, and pilot a HITSystem 2.0 version to improve attendance of PMTCT appointments, increase ART adherence and hospital-based deliveries, and prompt early infant diagnosis by 6 weeks postnatal. The HITSystem 2.0 aims improve the integration of maternal and pediatric HIV services. Trial registration: ClinicalTrials.gov: NCT02726607. Registered on April 1, 2016.

Identifying factors relevant for successful implementation of school-based interventions is essential to ensure that programs are provided in an effective and engaging manner. The perspectives of two key stakeholders critical for identifying implementation barriers and facilitators - students and their classroom teachers - merit attention in this context and have rarely been explored using qualitative methods. This study reports qualitative perspectives of fifth and sixth grade participants and their teachers of a 16-week school-based mindfulness and yoga program in three public schools serving low-income urban communities. Four themes related to program implementation barriers and facilitators emerged: program delivery factors, program buy-in, implementer communication with teachers, and instructor qualities. Feedback from students and teachers is discussed in the context of informing implementation, adaptation, and future development of school-based mindfulness and yoga programming in urban settings.

Context School-based mindfulness and yoga studies generally measure stress-related outcomes using quantitative measures. Objective This study answers the following research questions: How do youth define stress and in what ways, if any, was a mindful yoga intervention helpful to youth during stress experiences? Design and Subjects To explore youths' own perspectives on stress, stressors in youths' lives, and perceived changes in responses to stress post-intervention, we conducted focus group discussions with 22 middle school students from low-income urban communities following a 16-week mindful yoga intervention. Results Using thematic analysis, the following three themes emerged: (1) youth conflated stress with negative emotions; (2) peer and family conflicts were common stressors; and (3) youth reported improved impulse control and emotional regulation following the intervention. Study findings have implications for refining intervention content (e.g., discussions of stress), as well as informing the selection and development of quantitative measures for future research on stress and stress responses in urban youth.

Objectives. To estimate national need for family planning services among men in the United States according to background characteristics, access to care, receipt of services, and contraception use. Methods. We used weighted data from the 2006–2010 National Survey of Family Growth to estimate the percentage of men aged 15 to 44 years (n = 10 395) in need of family planning, based on sexual behavior, fecundity, and not trying to get pregnant with his partner. Results. Overall, 60% of men were in need of family planning, defined as those who ever had vaginal sex, were fecund, and had fecund partner(s) who were not trying to get pregnant with partner or partner(s) were not currently pregnant. The greatest need was among young and unmarried men. Most men in need of family planning had access to care, but few reported receiving family planning services ( Conclusions. The need for engaging men aged 15 to 44 years in family planning education and care is substantial and largely unmet despite national public health priorities to include men in reducing unintended pregnancies.

As school-based mindfulness and yoga programs gain popularity, the systematic study of fidelity of program implementation (FOI) is critical to provide a more robust understanding of the core components of mindfulness and yoga interventions, their potential to improve specified teacher and student outcomes, and our ability to implement these programs consistently and effectively. This paper reviews the current state of the science with respect to inclusion and reporting of FOI in peer-reviewed studies examining the effects of school-based mindfulness and/or yoga programs targeting students and/or teachers implemented in grades kindergarten through twelve (K-12) in North America. Electronic searches in PsychInfo and Web of Science from their inception through May 2014, in addition to hand searches of relevant review articles, identified 312 publications, 48 of which met inclusion criteria. Findings indicated a relative paucity of rigorous FOI. Fewer than 10 % of studies outlined potential core program components or referenced a formal theory of action, and fewer than 20 % assessed any aspect of FOI beyond participant dosage. The emerging nature of the evidence base provides a critical window of opportunity to grapple with key issues relevant to FOI of mindfulness-based and yoga programs, including identifying essential elements of these programs that should be faithfully implemented and how we might develop rigorous measures to accurately capture them. Consideration of these questions and suggested next steps are intended to help advance the emerging field of school-based mindfulness and yoga interventions.

Purpose Venous oxygenation (Yv) is an important index of brain physiology and may be indicative of brain diseases. A T2-relaxation-under-spin-tagging (TRUST) MRI technique was recently developed to measure Yv. A multisite evaluation of this technique would be an important step toward broader availability and potential clinical utilizations of Yv measures. Methods TRUST MRI was performed on a total of 250 healthy subjects, 125 from the developer's site and 25 each from five other sites. All sites were equipped with a 3 Tesla (T) MRI of the same vendor. The estimated Yv and the standard error (SE) of the estimation eYv were compared across sites. Results The averaged Yv and eYv across six sites were 61.1% ± 1.4% and 1.3% ± 0.2%, respectively. Multivariate regression analysis showed that the estimated Yv was dependent on age (P = 0.009) but not on performance site. In contrast, the SE of the Yv estimation was site-dependent (P = 0.024) but was less than 1.5%. Further analysis revealed that eYv was positively associated with the amount of subject motion (P

Neurofibromatosis type 1 (NF1) carries a significant psychosocial burden for affected individuals. The objective of this study was to measure the prevalence of depressive symptoms among a large sample of adults with NF1 and to quantify the impact of depressive symptoms on quality of life (QoL). This cross-sectional study used an Internet-based questionnaire to collect data from 498 adults who self-reported as having NF1. Using the Center for Epidemiologic Studies Depression (CESD) scale, 55% of all participants (61% of females and 43% of males) scored above 16, indicating a high likelihood of clinical depression. In a multivariate regression model controlling for demographics and potential confounders, depressive symptoms accounted for 32% of the variance in QoL as measured by the Quality of Life Index. This study is the largest to date and found the highest prevalence of depression compared to prior studies. Our data provide more compelling evidence that individuals with NF1 are at increased risk for psychiatric morbidity and suggest that this population should be routinely screened for depression. Because depression was found to be strongly associated with QoL and accounted for nearly one-third of the variance in QoL, it is likely that effectively treating depression may significantly enhance QoL for individuals with NF1.

Parentification refers to parents bestowing adult-like roles on children within families, and studies have linked parentification to individual differences in risk and resilience. The depth of our understanding of the pathways that translate parentification into risk for negative developmental outcomes remains shallow. This study examined whether parentification has a contextual effect moderating the expression of links between testosterone and antisocial behavior. Eighty-three participants (M age = 21.37 years, SD = 1.87; 48% Black; 60% female) were interviewed initially and one year later. Audio Computer Assisted Self-Interview methods were used to measure parentification and antisocial behavior. Saliva was sampled on multiple occasions and later assayed for testosterone. Results revealed, for both sexes, testosterone was positively associated with antisocial behavior at baseline and at follow-up when participants scored low on perceived benefits of parentification. This relationship became weaker as levels of perceived benefits of parentification increased. At the highest levels of perceived benefits of parentification, testosterone and antisocial behavior were inversely related. The findings suggest a potentially important role for perceptions of parentification as a moderator for the expression of hormone-behavior relationships and are discussed in terms of implications for the biosocial model of the family.

Recent research suggests human life history strategy (LHS) may be subsumed by multiple dimensions, including mating competition and Super-K, rather than one. In this study, we test whether a two-dimensional structure best fit data from a predominantly urban sample of young adults ages 18–24. We also test whether latent life history dimensions are associated with environmental harshness and unpredictability as predicted by life history theory. Results provide evidence that a two-dimensional model best fit the data. Furthermore, a moderate inverse residual correlation between mating competition and Super-K was found, consistent with a life history trade-off. Our findings suggest that parental socioeconomic status may enhance investment in mating competition, that harshness might persist into young adulthood as an important correlate of LHS, and that unpredictability may not have significant effects in young adulthood. These findings further support the contention that human LHS is multidimensional and environmental effects on LHS are more complex than previously suggested. The model presented provides a parsimonious explanation of an array of human behaviors and traits and can be used to inform public health initiatives, particularly with respect to the potential impact of environmental interventions.

Extensive interviews of correctional inmates in South Carolina (2009-2010) were conducted under a Center for Disease Control and Prevention (CDC) grant. We evaluated the extent to which early traumatic brain injury (TBI) and subsequent illicit drug abuse may conjointly influence development of aggression, controlling for alcohol use, and whether cognitive or emotional dysregulation mediated this relationship. Early TBI predicted greater severity and earlier onset of drug use, and an earlier age at first use predicted greater aggression regardless of the age of TBI. Emotional dysregulation mediated effects of TBI on aggression. The potential to design more targeted treatments for this susceptible population are discussed.

In the past years, the number of mindfulness-based intervention and prevention programs has increased steadily. In order to achieve the intended program outcomes, program implementers need to understand the essential and indispensable components that define a program's success. This chapter describes the complex process of identifying the core components of a mindfulness and yoga program for urban early adolescents through the systematic study of fidelity of implementation of the intervention. The authors illustrate the CORE Process [(C) Conceptualize Core Components; (O) Operationalize and measure; (R) Run analyses and Review implementation findings; and (E) Enhance and refine], based on data gained from a mindfulness and yoga intervention study conducted as a community-academic partnership in Baltimore city.

Purpose – Mindfulness-based interventions – which train capacities for attention, awareness, compassion, and self-regulation of thoughts and emotions – may offer unique benefits for urban youth exposed to chronic stress and adversity. Urban schools are promising settings in which to integrate mindfulness-based interventions; however, they pose complex challenges for intervention implementation and evaluation. Design/methodology/approach – The paper reflects on the experiences of our community-academic partnership conducting two school-based randomised trials on a mindfulness and yoga programme. The programme was developed by the Holistic Life Foundation and was delivered to middle school students in public schools serving disadvantaged urban communities. Findings – This paper discusses barriers and facilitating factors related to effective intervention delivery and evaluation, presents recommendations for future work and reflects on the potential benefits of mindfulness-based practices for students, teachers and schools. Originality/value – The paper offers a detailed account of challenges and opportunities associated with implementing mindfulness-based practices in urban school settings.

Provider-initiated conversations with people living with HIV about reproductive plans are lacking. Providers must know whether their patients want to bear children to tailor treatment and refer for HIV preconception counseling to help achieve patients’ reproductive goals while minimizing transmission to partners and children. The early focus on men who have sex with men largely excluded consideration of the epidemic’s impact on reproductive health. We used a historical review of the US epidemic to describe the problem’s scope and understand if this legacy underlies the current neglect of reproductive planning. Drawing on peer-reviewed literature, we discuss key themes relevant to assessing and understanding attention to desires for children among HIV-positive people. We conclude with recommendations for addressing persistent stigma and enhancing patient–provider communication about reproductive intentions.

Purpose To use cluster analysis to explore how coping, stress, and social support align and intersect with each other and relate to internalizing and externalizing behavior among urban adolescents and young adults disconnected from school and work. Methods Baseline audio computer assisted self-interview (ACASI) data from a study of 683 urban, low-income, African-American 16–24-year-old youth (mean age = 18.7; SD = 1.8) participating in an employment training program was cluster analyzed. This method reveals how well youth group together based on coping strategies, stress exposure, and social support. Results Using four coping, two support, and two stress subscales, a three-cluster solution best fit the data. One cluster, representing 65% of the sample, was characterized by moderate coping, high support, and low stress. These youth also reported lower weapon carrying compared to youth in the remaining two clusters. Another cluster, representing 17% of the sample, was defined by high coping, moderate support, and high stress. Youth in this cluster reported the highest levels of depressive symptoms and high levels of suicidal ideation as well as high levels of perpetrating intimate partner violence compared to other youth. The final cluster, also representing 17% of the sample, was marked by low coping, low support, and low stress. These youth also reported high levels of suicidal ideation. Conclusions Given the varying profiles of stress, support, and coping reported by urban adolescents and young adults, future research and policy should further explore targeted and tailored intervention approaches for these youth.

Previous studies on school-based mindfulness and yoga programs have focused primarily on quantitative measurement of program outcomes. This study used qualitative data to investigate program content and skills that students remembered and applied in their daily lives. Data were gathered following a 16-week mindfulness and yoga intervention delivered at three urban schools by a community non-profit organization. We conducted focus groups and interviews with nine classroom teachers who did not participate in the program and held six focus groups with 22 fifth and sixth grade program participants. This study addresses two primary research questions: (1) What skills did students learn, retain, and utilize outside the program? and (2) What changes did classroom teachers expect and observe among program recipients? Four major themes related to skill learning and application emerged as follows: (1) youths retained and utilized program skills involving breath work and poses; (2) knowledge about health benefits of these techniques promoted self-utilization and sharing of skills; (3) youths developed keener emotional appraisal that, coupled with new and improved emotional regulation skills, helped de-escalate negative emotions, promote calm, and reduce stress; and (4) youths and teachers reported realistic and optimistic expectations for future impact of acquired program skills. We discuss implications of these findings for guiding future research and practice.

Although a significant number of HIV-positive women intend to have children in the future, few work with providers to safely plan pregnancy. We conducted 20 semistructured in depth interviews with HIV-positive adolescent and adult women receiving HIV clinical care in an urban setting. Participants were purposively sampled to include diversity in age and childbearing plans. Interview transcripts were analyzed and coded independently by two study team members before reaching consensus on emergent themes. Among this sample of HIV-positive women (mean age=27.9, 95% African American, 50% on antiretroviral therapy [ART], 65% want a biological child), only 25% reported discussing their childbearing goals with their HIV provider. Women actively trying to conceive recognized the risk to themselves and their partner, but had not talked with their provider about safer conception strategies. Data regarding provider communication about childbearing were organized by the following emergent themes: (1) confusion and concern on how to conceive safely, (2) provider characteristics or dynamics that influenced communication, and (3) provider guidance offered regarding childbearing. Even in this unique study setting in which referrals for preconception counseling are possible, women were unaware of this specialized service. Provider initiated reproductive counseling is needed to strategically avoid or plan pregnancy and reduce risk of transmission to partners and infants rather than leaving it to chance, which can have major health implications.

This study examines gender, grade-level, and baseline depressive symptoms as potential moderators of a school-based mindfulness intervention's impact on the self-regulatory outcomes of urban youth. Ninety-seven participants from four urban public schools were randomly assigned to an intervention or wait-list control condition. Fourth and fifth graders in the intervention condition received a 12-week yoga-inspired mindfulness program. Using methods outlined by Aiken and West (1991), a series of models estimated the interaction effect of moderators of interest on adjusted posttest self-regulatory outcomes. Results indicate that gender and grade did not moderate intervention impacts. However, baseline depressive symptoms moderated both impulsive action and involuntary engagement stress responses such that intervention youth reporting lower levels of baseline depressive symptoms were more likely to evidence decreases in these problematic stress responses relative to control youth. Findings highlight the need for future studies to examine moderators of mindfulness-based interventions impacts on youth outcomes.

Despite a growing literature assessing pregnancy desires among HIV-infected women enrolled in clinical care, little attention has been paid to HIV-infected youth for whom pregnancy is a very relevant issue. In urban areas with high rates of teen pregnancy and HIV infection, further understanding of childbearing motivations and relationship dynamics influencing pregnancy desires among female youth is needed. This study compares the childbearing motivations, pregnancy desires, and perceived partner desire for a pregnancy among predominately African-American HIV-infected (n=46) and HIV-uninfected (n=355) female youth (15–24 years). An HIV-infected status was not significantly associated with childbearing motivations or the desire for a future pregnancy, p>0.10. HIV-infection was, however, associated with an increased likelihood to perceive that one's partner would have a positive response to a pregnancy (adjusted odds ratio [aOR] 3.5, 95% confidence interval [CI] 1.2–10.4, p=0.02) compared to uninfected peer...

In the National Longitudinal Survey of Youth 1979 (NLSY79), young fathers include heterogeneous subgroups with varying early life pathways in terms of fatherhood timing, the timing of first marriage, and holding full-time employment. Using latent class growth analysis with 10 observations between ages 18 and 37, we derived five latent classes with median ages of first fatherhood below the cohort median (26.4), constituting distinct early fatherhood pathways representing 32.4% of NLSY men: (A) Young Married Fathers, (B) Teen Married Fathers, (C) Young Underemployed Married Fathers, (D) Young Underemployed Single Fathers, and (E) Young Later-Marrying Fathers. A sixth latent class of men who become fathers around the cohort median, following full-time employment and marriage (On-Time On-Sequence Fathers), is the comparison group. With sociodemographic background controlled, all early fatherhood pathways show disadvantage in at least some later-life circumstances (earnings, educational attainment, marital status, and incarceration). The extent of disadvantage is greater when early fatherhood occurs at relatively younger ages (before age 20), occurs outside marriage, or occurs outside full-time employment. The relative disadvantage associated with early fatherhood, unlike early motherhood, increases over the life course.

Purpose Self-reports are the standard measure of STD history used in survey research. We explored to what extent self-reports of ever having an STD are recanted in a follow-up data collection. Methods Using the National Survey of Adolescent Males (NSAM), we assessed consistency over time in self-reports of ever having an STD in a sample of young men transitioning from adolescence to young adulthood (aged 15–26 years), a population in which STDs are particularly prevalent. Results Approximately 7% of all sexually experienced young men rescinded STD self-reports over time. Thus, self-reports at one point in time likely underestimate true STD history, using earlier self-reports as the criterion. Among men who ever report an STD, 94-98% recant their reports in later waves. Conclusions Knowledge of the extent of underreporting can potentially be used to adjust cross-sectional estimates of STDs based on survey self-reports. These study findings move us one step closer to estimating just how much underreporting of STDs in self-reports is.

Widespread replications of evidence-based prevention programs (EBPPs) prompt prevention scientists to examine program implementation adherence in real world settings. Based on Chen's model (1990), we identified five key factors of the implementation system and assessed which characteristics related to program adherence. The sample included 32 EBPPs and results indicate that target recipient responsivity, program material quality, implementer prioritization, community collaborative system support, and parental support significantly relate to program adherence. Several differences reached statistical significance, thereby highlighting the importance of these variables and the need for future studies with larger sample sizes to identify factors related to program adherence adequately. © 2008 Wiley Periodicals, Inc.

The study investigated the relationship between latent trait testosterone (LTT) and risk-taking among 126 youth ( M age = 21.34 years; 56% female; 52% African American). Latent state-trait (LST) modeling isolates observed variance of samples via their correlations into (1) a latent trait testosterone (LTT) factor capturing individual differences, and (2) a component of state testosterone factor (LST) capturing state-specific situational or environmental influences and random error variances. Participants provided four laboratory (20 min apart) and four home (waking, 20-min post-waking, noon, evening) salivary samples (later assayed for testosterone). Participants reported risk-taking tendencies and behaviors via an Audio Computer Assisted Self-Interview. Behavioral risk was measured using the Balloon Analog Risk Task. Results revealed: (1) LTT model invariance (operated similarly) for females and males; (2) LTT accounted for 18–89% (home samples) and 61–95% (lab samples) of the variance in testosterone levels, and (3) LTT was associated with risk-seeking behaviors and the strength of this association was similar across males and females. LST Modeling has potential to advance our understanding of testosterone-behavior associations to new limits by estimating stable trait-like components of the variance in testosterone levels.

Background Early infant diagnosis among human immunodeficiency virus (HIV)-exposed infants is a critical component of prevention of mother-to-child transmission programs. Barriers to early infant diagnosis include poor uptake, low retention at designated re-testing intervals, delayed test results, passive systems of communication, and poor linkage to treatment. This study will evaluate the HIV Infant Tracking System (HITSystem), an eHealth intervention that streamlines communication and accountability between the key early infant diagnosis stakeholders: HIV+ mothers and their HIV-exposed infants, healthcare providers, and central laboratory personnel. It is hypothesized that the HITSystem will significantly improve early infant diagnosis retention at 9 and 18 months postnatal and the timely provision of services. Methods/design Using a phased cluster-randomized controlled trial design, we will evaluate the impact of the HITSystem on eight primary benchmarks in the 18-month long cascade of care for early infant diagnosis. Study sites are six government hospitals in Kenya matched on geographic region, resource level, and patient volume. Early infant diagnosis outcomes of mother-infant dyads (n = 120 per site) at intervention hospitals (n = 3) where the HITSystem is deployed at baseline will be compared to the matched control sites providing standard care. After allowing for sufficient time for enrollment and 18-month follow-up of dyads, the HITSystem will be deployed at the control sites in the end of Year 3. Primary outcomes are retention among mother-infant dyads, initiation of antiretroviral therapy among HIV-infected infants, and the proportion of services delivered within the optimal time window indicated by national and study guidelines. Satisfaction interviews with participants and providers will inform intervention improvements. Cost-effectiveness analyses will be conducted to inform the sustainability of the HITSystem. Hypothesized outcomes include significantly higher retention throughout the 18-month early infant diagnosis process, significantly more services provided on-time at intervention sites, and a potential savings to the healthcare system. Discussion This study will evaluate the public health impact of the HITSystem to improve critical early infant diagnosis outcomes in low-resource settings. Cost-effectiveness analyses will inform the feasibility of scale-up in other settings. Trial registration ClinicalTrials.gov: NCT02072603

Preconception care for men focuses on prevention strategies implemented prior to conception of a first or subsequent pregnancy to improve pregnancy and infant outcomes. Little is known about U.S. men in need of preconception care. This analysis describes the proportion of men in need of preconception care and associations of these needs by background characteristics, related health conditions, access to care and receipt of services. Data from men aged 15–44 in the National Survey of Family Growth 2006–2010 were analyzed to describe men in need of preconception care, based on future childbearing intentions and self and partner fecundity status (among sexually experienced only), and associated factors with these needs using weighted bivariate analyses. About 60 % of men are in need of preconception care. Higher prevalence of being in need was observed among men aged 15–29 than older; living in urban than non-urban settings; in school than not in school regardless of working status; not in a coresidential union than married or cohabiting; who were recent immigrants than U.S. born; and reporting never having had a child than ≥1 child(ren). Men in need were overweight/obese (56 %), ever binge drank in the last year (58 %), and have high STI risk (21 %). The majority of men in need reported access to care in the last year (>70 %), but few reported receipt of services including STD/HIV testing (

Youth under 25 show substantial sexual and substance use risk behaviors. One factor associated with risk behaviors is delay discounting, the devaluation of delayed outcomes. This study determined if delay discounting for sexual outcomes is related to sexual risk and substance use among 18-24 year olds. Females (70) and males (56) completed the Sexual Discounting Task, which assessed their likelihood of having unprotected immediate sex versus waiting for sex with a condom, at various delays, with 4 hypothetical sexual partners selected from photographs: the person they most wanted to have sex with, least wanted to have sex with, judged most likely to have a sexually transmitted infection (STI), and judged least likely to have an STI. They also completed instruments assessing HIV knowledge, sexual behaviors, substance use, risk attitudes, inhibition, impulsivity, and sensation-seeking. Condom use likelihood generally decreased with increasing delay. Preference for immediate, unprotected sex was greater for partners whom participants most (vs. least) wanted to have sex with and judged least (vs. most) likely to have an STI. Preference for immediate, unprotected sex in the "most want to have sex with" and "least likely to have an STI" conditions was related to greater lifetime risky sexual partners, lifetime number of unique substances used, disregard of social approval/danger, disinhibition, and sensation/excitement-seeking. Males showed greater likelihood of unprotected sex than females when condom use was undelayed, but delay similarly affected condom use between sexes. Delay discounting should be considered in strategies to minimize youth risk behavior.