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BackgroundRecent calls to action have been made for Implementation Science to attend to health inequities at the intersections of race, gender, and social injustice in the United States. Transgender people, particularly Black and Latina transgender women, experience a range of health inequities and social injustices. In this study, we compared two processes of transgender community engagement in Los Angeles and in Chicago as an implementation strategy to address inequitable access to care; we adapted and extended the Exploration Planning Implementation and Sustainment (EPIS) framework for transgender health equity.MethodsA comparative case method and the EPIS framework were used to examine parallel implementation strategies of transgender community engagement to expand access to care. To foster conceptual development and adaptation of EPIS for trans health equity, the comparative case method required detailed description, exploration, and analyses of the community-engagement processes that led to different interventions to expand access. In both cities, the unit of analysis was a steering committee made up of local transgender and cisgender stakeholders.ResultsBoth steering committees initiated their exploration processes with World Café-style, transgender community-engaged events in order to assess community needs and structural barriers to healthcare. The steering committees curated activities that amplified the voices of transgender community members among stakeholders, encouraging more effective and collaborative ways to advance transgender health equity. Based on analysis and findings from the Los Angeles town hall, the steering committee worked with a local medical school, extending the transgender medicine curriculum, and incorporating elements of transgender community-engagement. The Chicago steering committee determined from their findings that the most impactful intervention on structural racism and barriers to healthcare access would be to design and pilot an employment program for Black and Latina transgender women.ConclusionIn Los Angeles and Chicago, transgender community engagement guided implementation processes and led to critical insights regarding specific, local barriers to healthcare. The steering committee itself represented an important vehicle for individual-, organizational-, and community-level relationship and capacity building. This comparative case study highlights key adaptations of EPIS toward the formation of an implementation science framework for transgender health equity.

In Los Angeles County, Black people represent 9% of the general population yet comprise 40% of the homeless population. In its 2018 groundbreaking report, the Los Angeles Homeless Services Authority Ad Hoc Committee on Black People with Lived Experience of Homelessness concluded that homelessness is a by-product of racism in the United States. The Committee also found racial inequities in outcomes for Black residents of homeless services, particularly Permanent Supportive Housing (PSH).This report, in partnership with LAHSA and community-based service providers, further examines why there are racial inequities in returns to homelessness or interim housing for Black PSH residents. To estimate the racial inequity in returns to homelessness, we used administrative data from the Homelessness Management Information System (HMIS). To identify potential factors that contribute to Black residents falling out of PSH and returning to homelessness, we conducted interviews and focus groups with PSH program managers, case managers, and Black residents.This work has been supported, in part, by the University of California Multicampus Research Programs and Initiatives grants MRP-19-600774 and M21PR3278.

Objectives: We sought to understand the stressors, the parent-child relationship and family processes, and experiences with services among families experiencing parental substance use disorders (SUDs) and homelessness. Methods: We conducted a total of 41 in-depth semistructured interviews with parents with a history of SUDs and homelessness (n = 16) and housing support staff (n = 25) from May 2017 until January 2018. Participants were recruited from transitional housing facilities across the Los Angeles metropolitan area, which served families experiencing homelessness and parental SUDs. The interviews were audio-recorded, transcribed, and themes coded with Dedoose. Results: We found a high burden of trauma and guilt among parents, and a fear of SUD disclosure. We found challenges with family processes important for SUD prevention, including communication, discussion of substance use, and family and youth goal setting. We also discovered unique stressors related to navigating housing and services within the community. Conclusion: Our findings demonstrate the need for a family-based SUD-preventive intervention for youth growing up in families with parental SUDs and experiencing homelessness, to address the heightened SUD risk. In addition, findings from our study can inform clinical and housing services for this important population.

Introduction: Little is known about geosocial networking dating application use among young Black gay and bisexual men (YBGBM), a group severely affected by HIV in the United States. The purpose of this study was to explore: (1) How YBGBM describe motivations to use Jack'd; (2) How YBGBM describe and experience meeting romantic-sexual partners on Jack'd, including partner preferences and offline sexual encounters; and (3) How these descriptions and experiences reflect sexual risk behaviors? Methods: Between April and July 2015, we conducted 23 face-to-face semistructured interviews with self-identified Black gay (n = 15) and bisexual (n = 8) men (21-25 years) (M = 23.48, SD = 1.5) in Washington, DC. All interviews were audio-recorded, transcribed, and analyzed using thematic analysis methodology. Results: Motivations to use Jack'd included discomfort and challenges meeting men in open/public spaces that may lead to homophobic violence. Nearly half articulated distrust of HIV-negative disclosure from their Jack'd-met partner. Some participants reported inconsistent condom use when the insertive partner in anal sex, and several perceived Jack'd-met partners their own age to be less concerned about HIV than older men. Conclusion: HIV prevention strategies directed toward YBGBM should consider the role dating applications may play in either exacerbating or attenuating sexual risk.

We conducted focus groups with defense lawyers, clinicians, and education advocates to gather their perspectives on families' experiences with the juvenile justice system. Our quantitative descriptive analysis identified a range of themes such as discussions about the poor treatment of families as well as recommendations for a shifting of power to families. These perspectives may provide insights about the context in which families are expected to participate in interventions, meet probationary demands, and provide for their youth's well-being. The results support evidence gathered from families about the impact of youth incarceration on their lives and has implications for practitioners and researchers working with families whose youth have been incarcerated.

ObjectiveAdolescent suicidal behavior is a public health concern in South Africa. The purpose of this article is to report on the development of a screening tool for teachers to identify South African students who are most at risk for suicidal behavior. This need is addressed within the context of the limited number of mental health professionals available to provide screening and care services in South Africa.MethodGrade 8 students participated by completing sociodemographic questionnaires and self-report psychometric instruments. A screening tool for suicidal behavior was developed using a 4-phase approach.ResultsTwelve factors for high-risk suicidal behavior were identified and included in the screening tool. While further research is needed to validate the screening tool, the findings provide a useful preliminary starting point for teachers to refer students at high risk for suicidal behavior to mental health services for treatment.ConclusionThis screening tool is based on factors that were identified as being associated with suicidal behavior from local research on South African adolescents. The tool contributes to research on adolescent mental health, particularly suicidal behavior, in developing low and middle income countries like South Africa, with the aim of creating African prevention and intervention programs. (PsycINFO Database Record

Theater-based approaches have been implemented globally as a health education and behavior change strategy for decades. Studies have shown that live theater performances can engage an audience and influence the knowledge, attitudes, and behaviors of audience members. Moreover, literature has shown that adolescents find theater-based interventions to be more acceptable and memorable than traditional didactic teaching methods. Few studies, however, have compared the effect of different intervention delivery modes on adolescents' sexual health knowledge, attitudes, and beliefs. The present study aims to fill this gap in the literature and to evaluate the efficacy of two delivery modes (live and virtual) of a theater-based sexual health intervention for promoting sexual health strategies among adolescents. A total of 300 high school students were included in this study. Participants in both the live and virtual modes reported increased HIV knowledge and improved safe sex self-efficacy, suggesting that the live and virtual modes have comparable impact. Given the low cost and resource demands, these findings support the utilization of a virtual program as a promising practice for disseminating a sexual health intervention targeting adolescents on a large scale.

AMP! (Arts-based, Multiple component, Peer-education) is an HIV intervention developed for high school adolescents. AMP! uses interactive theater-based scenarios developed by trained college undergraduates to deliver messages addressing HIV/STI prevention strategies, healthy relationships, and stigma reduction towards people living with HIV/AIDS. We used a pre-test/post-test, control group study design to simultaneously assess intervention effect on ninth grade students in an urban county in California (N = 159) and a suburban county in North Carolina (N = 317). In each location, the control group received standard health education curricula delivered by teachers; the intervention group received AMP! in addition to standard health education curricula. Structural equation modeling was used to determine intervention effects. The post-test sample was 46 % male, 90 % self-identified as heterosexual, 32 % reported receiving free or reduced lunch, and 49 % White. Structural models indicated that participation in AMP! predicted higher scores on HIV knowledge (p = 0.05), HIV awareness (p = 0.01), and HIV attitudes (p = 0.05) at the post-test. Latent means comparison analyses revealed post-test scores were significantly higher than pre-test scores on HIV knowledge (p = 0.001), HIV awareness (p = 0.001), and HIV attitudes (p = 0.001). Further analyses indicated that scores rose for both groups, but the post-test scores of intervention participants were significantly higher than controls (HIV knowledge (p = 0.01), HIV awareness (p = 0.01), and HIV attitudes (p = 0.05)). Thus, AMP!'s theater-based approach shows promise for addressing multiple adolescent risk factors and attitudes concerning HIV in school settings.

Adolescents in wartime US military families are a unique group of young people who are experiencing the usual milestones of adolescent development, including establishing their identities and becoming autonomous, while they face the challenges of military life such as multiple frequent moves, relocation, and parent deployment to combat settings. This paper reviews research on adolescents in wartime US military families, within the context of adolescent development, to identify their behavioral, emotional and academic risk status, and challenges and resources. Recommendations for future research and interventions to foster the healthy development of these adolescents are also provided.

Recent studies on homeless adolescents suggest that the profiles of homeless adolescents are heterogeneous, and that certain clusters of homeless adolescents demonstrated resiliency and positive coping strategies. This study examined the relationship between HIV-related risk factors and resiliency (survival skills) of homeless adolescents over a 2-year period. Those who did not engage in unprotected sex reported significantly higher survival skills scores. Similarly, those who were monogamous during the study period reported significantly higher survival skills scores. However, there was a significant decline in survival skills scores after 6 months, regardless of the HIV-related risk factors. Findings from this study point to the urgent need to identify and target resilient adolescents early on to provide interventions to facilitate the transition to stable living situations before their resiliency deteriorates.

Using cluster analysis techniques, we identified two distinct clusters of newly homeless adolescents in Los Angeles (n = 261): those who are protected and doing relatively well while out of home with more protective than risk factors, and those who are risky with more risk than protective factors. The objective of this study was to examine the trajectories of human immunodeficiency virus (HIV) risk behaviors and exiting homelessness among protected newly homeless adolescents, compared to those who are classified as risky. HIV risk behavior included unprotected sex, having multiple sex partners and hard drug use. Logistic regression mixed-effects models were used to evaluate the trajectories of HIV risk behaviors and exiting homelessness over time. The adolescents in the protected group reported significantly less unprotected sex ( p = 0.0156), being abstinent or monogamous ( p < 0.0001) and less hard drug use ( p < 0.0001) compared to the adolescents in the risky group. In addition, the protected group reported more "exiting homelessness", compared to the risky group ( p = 0.0007). However, the differences in the level of unprotected sex between the protected and risky groups decreased over time. Our findings confirm the notion that newly homeless adolescents are indeed heterogeneous. Given that the risk behavior profiles of protected group merges to the risky group over time, our findings underscore the need to mount tailored interventions to be designed for the protected group early in the process.

There is growing evidence to support developing new typologies for homeless adolescents. Current typologies focus on the risks associated with being homeless, with less consideration of the positive attributes of homeless adolescents. The authors examined both risk and protective factors in a sample of newly homeless adolescents. Using cluster analysis techniques, they identified three distinct clusters of newly homeless adolescents: those who are protected and doing relatively well while out of home with more protective than risk factors, those who are at-risk, and those who are risky with more risk than protective factors. Over half (51.9%) of these newly homeless adolescents were in the protected cluster. This typology has implications for the design and implementation of services and interventions for newly homeless adolescents to reconnect them with stable housing situations.

The Risk Amplification and Abatement Model (RAAM) demonstrates that negative contact with socializing agents amplify risk, while positive contact abates risk for homeless adolescents. To test this model, the likelihood of exiting homelessness and returning to familial housing at 2 years and stably exiting over time are examined with longitudinal data collected from 183 newly homeless adolescents followed over 2 years in Los Angeles, CA. In support of RAAM, unadjusted odds of exiting at 2 years and stably exiting over 2 years revealed that engagement with prosocial peers, maternal social support, and continued school attendance all promoted exiting behaviors. Simultaneously, exposure to family violence and reliance on shelter services discouraged stably exiting behaviors. Implications for family-based interventions are proposed.

There is growing evidence to support developing new typologies for homeless adolescents. Current typologies focus on the risks associated with being homeless, with less consideration of the positive attributes of homeless adolescents. The authors examined both risk and protective factors in a sample of newly homeless adolescents. Using cluster analysis techniques, they identified three distinct clusters of newly homeless adolescents: those who are protected and doing relatively well while out of home with more protective than risk factors, those who are at-risk, and those who are risky with more risk than protective factors. Over half (51.9%) of these newly homeless adolescents were in the protected cluster. This typology has implications for the design and implementation of services and interventions for newly homeless adolescents to reconnect them with stable housing situations. (Contains 3 tables and 3 footnotes.)

The impact of countervailing social network influences (i.e., pro-social, anti-social or HIV risk peers) on problem behaviors (i.e., HIV drug risk, HIV sex risk or anti-social behaviors) among 696 homeless youth was assessed using structural equation modeling. Results revealed that older youth were less likely to report having pro-social peers and were more likely to have HIV risk and anti-social peers. A longer time homeless predicted fewer pro-social peers, more anti-social peers, and more HIV risk peers. Heterosexual youth reported fewer HIV risk peers and more pro-social peers. Youth recruited at agencies were more likely to report pro-social peers. Having pro-social peers predicted less HIV sex risk behavior and less anti-social behavior. Having HIV risk peers predicted all problem behavior outcomes. Anti-social peers predicted more anti-social behavior. Once the association between anti-social and HIV risk peers was accounted for independently, having anti-social peers did not independently predict sex or drug risk behaviors. (Contains 2 figures and 2 tables.)

A census of homeless youth was conducted in locations across Los Angeles County, California. Building on previous research that has focused on homeless youth in cruise areas, the authors examined demographic and behavioral differences between homeless youth in cruise and noncruise areas. Youth in cruise areas were more likely than youth in noncruise areas to be older, to have been away from home longer, to have recently visited community-based agencies, and were likely to have resided in shelters and less likely to attend school. These data suggest possible selection bias in earlier studies that relied primarily on homeless youth from cruise areas.

This article presents a three-module intervention based on social action theory that focuses on health promotion and social identity formation for seropositive youth. The modules are designed to reduce transmission of HIV by reducing sexual and substance abuse acts, increasing healthy acts and adherence to care, and maintaining positive behavioral routines. Components of the modules are described, including examples of how these components are implemented in the actual intervention sessions. The importance of using successive approximation to consolidate changes in behavior by defining social roles and personal identities that are consistent with positive behavioral routines is demonstrated. Outcomes of the intervention are presented as well as issues of cost-effectiveness, feasibility, and alternative implementation strategies.