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An earlier trial of a school-based, preventative intervention, HealthWise South Africa, demonstrated some efficacy in preventing adolescent drinking and smoking in the Western Cape, South Africa. This was followed by the current implementation trial, which examined how implementation support conditions influenced adolescent drinking and smoking behavior change in the HealthWise intervention. The hybridized implementation-effectiveness trial included 34 schools (n = 2175 students) that provided student data at four waves through Grades 8 to 10. Implementation support conditions included a combination of two components (enhanced school environment and teacher consultation), resulting in four conditions: enhanced school environment, teacher consultation, both components, and standard delivery. Using configural frequency analysis, we examined how drinking and smoking behavior change differed across four configurations of intervention support longitudinally and by gender. For baseline non-smokers, results indicated sustained differences in abstention from smoking and smoking initiation between schools that received both support components and schools in the standard delivery condition. These results were primarily driven by girls. For baseline drinkers and smokers in the both components condition, changes in drinking were delayed until Grade 9 and smoking delayed by Grade 10. Results suggest that providing both school and teacher implementation support synergistically facilitates improved intervention outcomes both immediately following intervention and 2 years later across schools with diverse resource levels. Future iterations of HealthWise, and other interventions, may benefit from a multilevel implementation support strategy to improve student outcomes. More research is needed to understand how to improve HealthWise effectiveness among boys.

Background: Pre-exposure prophylaxis (PrEP) has demonstrated efficacy for HIV prevention, yet uptake of PrEP among populations in urgent need of prevention tools (eg, Black sexual minority men) is limited, and stigma and medical mistrust remain strong barriers to accessing PrEP. Purpose: To evaluate a test of concept brief intervention to address stigma and medical mistrust as barriers to PrEP uptake using novel latent profile analysis. Methods: Participants (N = 177) residing in the southeastern US were randomized to 1 of 4 arms to establish the potential impact of a brief, stigma focused counseling intervention (referred to as Jumpstart) to increase PrEP uptake. We estimated intervention effect size (Cramer’s V) for PrEP uptake and then explored differential intervention effects across latent profiles of psychosocial barriers to PrEP use. Results: The intervention resulted in small, but meaningful effect size, with self-reported PrEP uptake increasing across Jumpstart conditions with the control condition reporting 24% uptake and Jumpstart plus text/phone calls (the most intensive intervention arm) reporting 37% uptake, and a similar pattern emerging for biologically confirmed PrEP use. Among participants 30 and older, Jumpstart participants were more likely to move to a postintervention profile with fewer barriers than control participants and reported the highest uptake of PrEP. Conclusions: Addressing social/emotional barriers to PrEP uptake is an essential component of bridging the gap between advances being made in biomedical forms of HIV prevention, and establishing and supporting access to those advances. [ABSTRACT FROM AUTHOR]

Leisure diversity—the total number of unique leisure categories shared within a sibling dyad—may vary according to sibling characteristics (e.g., sibling gender, age difference) and predict sibling relationship quality. Using triangulated lists, brief narratives, and focus groups, we constructed a taxonomy of shared sibling leisure in emerging adulthood and then calculated individual leisure diversity scores. The sample (N = 185) included college-attending emerging adults with an average age of 20.1 years (35.7% female). Taxonomic analysis suggested 19 categories of shared sibling leisure. Analyses of variance indicated differences by dyadic gender composition in endorsement rates of select leisure categories and average levels of leisure diversity (lowest for mixed-gender dyads). Greater shared leisure diversity was associated with higher levels of affective (sister–sister dyads) and cognitive relationship quality (sister–sister and mixed-gender dyads). The association of leisure diversity with sibling relationship quality was strongest for sister–sister dyads and not significant for brother–brother dyads. Sibling dyads that include a sister are more likely to be impacted by the level of shared leisure diversity. The results of this study introduce leisure diversity as a metric for quantifying sibling leisure and support its potential as a means for understanding and impacting sibling relationship quality in emerging adulthood. [ABSTRACT FROM AUTHOR]

During a period of newly attained freedom preceding commitments expected in adulthood, emerging adults are faced with the major task of identity development. Leisure provides a context with relative freedom wherein emerging adults explore new experiences and access opportunities not always available in more constrained environments like work and school. In this case study of 40 emerging adults from 18 countries (Mage = 23.14 years), qualitative interviews were used to investigate the role of leisure as a context for identity development. Results indicate five major themes for leisure-based identity development in emerging adulthood: discovering identity, forming identity, defining identity, positioning identity, and forgoing opportunities. These themes support leisure as an additional context wherein emerging adults may flourish on the pathway toward adulthood. Access to both novel and familiar leisure provide a context for emerging adults to actively direct their identity development through decisions made in leisure time. [ABSTRACT FROM PUBLISHER]