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Sexual violence and sexual harassment (SVSH) are prevalent among college and university students; however, the experiences of ethnic minority students, especially Asians, are understudied. This study aimed to reduce this gap by exploring Asian students perceptions of SVSH on three public university campuses in Southern California. We examined their perceptions about the campus environment related to SVSH, attitudes, and behaviors toward help seeking, and utilization of on-campus resources. A total of 23 in-depth interviews were conducted with Asian students enrolled at the three University of California campuses. Thematic coding was conducted to generate main themes and subthemes. Five main themes emerged: (a) SVSH is considered a taboo topic in Asian culture and family systems, and Asian student survivors are often reluctant to disclose incidents or seek support services. (b) Students did not feel their campus environments were tailored to understand or meet the sociocultural realities and needs of Asian student survivors. (c) Campus SVSH services and reporting processes were seen as non-transparent. (d) Peers were the major source of support and SVSH information, as opposed to official campus-based resources and training. (e) Survivors often conduct an internal cost-benefit analysis evaluating their decision about whether to report. This study highlights the lack of conversation surrounding SVSH in Asian families, and how the cultural stigma of sex and sexual violence prevented Asian students from receiving knowledge and resources about these topics in their families. Instead of relying on formal campus resources (e.g., Title IX and confidential advocacy services, mental health services), many students turn to their peers for support. Thus, facilitating peer support groups, training university students to support each other through SVSH incidents, and tailoring campus services to the diverse cultural backgrounds of students are key considerations to foster a safe campus environment and prevent SVSH.

BackgroundThe pandemic of SARS-CoV-2, which causes COVID-19, has caused disruptions in ongoing clinical trials and is expected to accelerate interest in conducting research studies remotely. ObjectiveA quasi-experimental, mixed methods approach was used to examine the rates of visit completion as well as the opinions and experiences of participants enrolled in an ongoing clinical trial of smoking cessation who were required to change from in-person clinic visits to remote visits using video or telephone conferencing due to the COVID-19 pandemic. MethodsFor quantitative comparisons, we used a quasi-experimental design, comparing a cohort of participants followed during the pandemic (n=23, COVID-19 cohort) to a comparable cohort of participants followed over a similar time period in the calendar years 2018 and 2019 (n=51, pre–COVID-19 cohort) to examine the rates of completion of scheduled visits and biospecimen collection. For the qualitative component, interviews were conducted with participants who experienced the transition from in-person to remote visits. ResultsParticipants in the COVID-19 cohort completed an average of 83.6% of remote clinic visits (95% CI 73.1%-91.2%), which was not significantly different than the in-person completion rate of 89.8% in the pre–COVID-19 cohort. Participants in the COVID-19 cohort returned an average of 93.2% (95% CI 83.5%-98.1%) of saliva specimens for remote clinic visits completed, which was not significantly different than the in-person saliva specimen completion rate of 100% in the pre–COVID-19 cohort. Two broad themes emerged from the qualitative data: (1) the benefits of remote visits and (2) the challenges of remote counseling compared to in-person counseling. Despite limited experience with telehealth prior to this transition, most participants expressed a willingness to engage in remote visits in the future. ConclusionsEven in the context of a rapid transition from in-person to remote visits necessitated by the COVID-19 pandemic, rates of visit completion and return of biospecimens remained high. Participants were generally accepting of the transition. Further research is needed to identify the optimal mix of in-person and remote visits beyond the pandemic context and to better understand how these changes may impact study outcomes. Trial RegistrationClinicalTrials.gov NCT03262662; https://clinicaltrials.gov/ct2/show/study/NCT03262662

BackgroundDespite the increasing number of youth seeking health information on the internet, few studies have been conducted to measure digital health literacy in this population. The digital health literacy instrument (DHLI) is defined as a scale that measures the ability to operate digital devices and read and write in web-based modes, and it assesses seven subconstructs: operational skills, navigation skills, information searching, evaluating reliability, determining relevance, adding self-generated content to a web-based app, and protecting privacy. Currently, there is no validation process of this instrument among adolescents. ObjectiveThis study aims to explore the usability and content validity of DHLI. MethodsUpon the approval of institutional review board protocol, cognitive interviews were conducted. A total of 34 adolescents aged 10-18 years (n=17, 50% female) participated in individual cognitive interviews. Two rounds of concurrent cognitive interviews were conducted to assess the content validity of DHLI using the thinking aloud method and probing questions. ResultsClarity related to unclear wording, undefined technical terms, vague terms, and difficult vocabularies was a major issue identified. Problems related to potentially inappropriate assumptions were also identified. In addition, concerns related to recall bias and socially sensitive phenomena were raised. No issues regarding response options or instrument instructions were noted. ConclusionsThe initial round of interviews provided a potential resolution to the problems identified with comprehension and communication, whereas the second round prompted improvement in content validity. Dual rounds of cognitive interviews provided substantial insights into survey interpretation when introduced to US adolescents. This study examined the validity of the DHLI and suggests revision points for assessing adolescent digital health literacy.

BackgroundMost training programs for self-management of chronic diseases in Korea currently involve face-to-face interactions primarily in a health care setting. Therefore, older Koreans living in the community continue to seek other training opportunities for the management of chronic diseases. This has led to the development of new training methods, such as mobile health (mHealth) care, which are valuable in community centers and homes. ObjectiveThis feasibility study (1) developed an mHealth training protocol to empower community-dwelling elderly individuals to manage their chronic diseases; (2) examined the feasibility of delivering this mHealth training protocol to elderly individuals through mobile tablets and applications (apps); and (3) discussed the contextual and methodological challenges associated with the development of this protocol. MethodsThe mHealth training protocol was developed based on the eHealth Enhanced Chronic Care Model and comprised of four phases. Phase 1 included standardized technology (mobile tablets) training using guidebooks, demonstrations, and guided practice. Phase 2 included provision of standardized information about disease management that was obtained from governmental and professional health care organizations. Phase 3 included provision of training on the use of high-quality mHealth apps that were selected based on individual diagnoses. Phase 4 included encouraging the patients to practice using self-selected mHealth apps based on their individual needs. Quantitative descriptive statistics and qualitative content analyses of user evaluations were used to assess the feasibility and user acceptance of this protocol. ResultsOf the 27 older adults included in this study, 25 completed all 4 weeks of the mHealth training. The attrition rate was 7% (2/27), and the reasons included time conflicts, emotional distress, and/or family discouragement. The men required little or no training for Phase 1, and in comparison with men, women seemed to depend more on the mHealth trainers in Phase 3. Gender, level of education, and previous experience of using smartphones were associated with the speed of learning, level of confidence, and overall competence. ConclusionsA tailored and personalized approach is required to develop mHealth training protocols for older adults. Self-management of chronic diseases via mHealth training requires careful consideration of the complex nature of human behavior, emotional responses, and familial influences. Therefore, integration of a theoretical, clinical, and technical approach is necessary for the successful development and implementation of an mHealth training program that targets older adults with chronic diseases in a community setting.

BackgroundInternet-based health resources can support informal caregivers who are caring for children or adolescents with health care needs. However, few studies discriminate informal caregivers’ needs from those of their care recipients or those of people caring for adults. ObjectiveThis study reviews the literature of health-related Internet use among informal caregivers of children and adolescents. MethodsA total of 17 studies were selected from literature searches conducted in 6 electronic databases: PubMed, Cochrane, CINAHL, PsycINFO, ERIC, and EMBASE. All databases searches were limited to articles published in the years 2004 to 2014 in peer-reviewed publications. Search terms consisted of “health-related Internet use,” “eHealth,” “Internet use for health-related purpose(s),” “Web-based resource(s),” and “online resources,” combined with informal caregiver (or “parents”) of “child,” “adolescent,” “student,” “youth,” and “teen.” The age range of the children receiving care was limited to younger than 22 years. Their informal caregivers were defined as persons (parents) who provided unpaid care or assistance to a child or an adolescent with health problems. ResultsAmong 17 empirical studies, the majority of informal caregivers of children with medical issues were the parents. Quantitative studies (14/17, 77%) reported prevalence and predictors of health-related Internet use, while mixed-methods and qualitative studies (3/17, 24%) investigated informal caregiver perceptions of helpful health-related Internet use and barriers of use. The prevalence of health-related Internet use varied (11%-90%) dependent upon how health-related Internet use was operationalized and measured. Disease-specific information was used for decision making about treatment, while social support via virtual communities and email were used for informal caregiver emotional needs. A digital divide of Internet access was identified in lower educated minorities. Most studies had methodological challenges resulting from convenience sampling, cross-sectional surveys, lack of theoretical frameworks, or no clear definitions of health-related Internet use. ConclusionsThis study provides an important understanding of how family members use Internet-based information and support systems during child caregiving. Healthcare providers and policy makers should integrate family needs into their current practices and policies. Further rigorous research is required to design efficient and effective nursing interventions.

BackgroundCongenital syphilis is preventable through timely access to prenatal care, syphilis screening and treatment of pregnant women diagnosed as infected. In 2018, California had the second highest number of congenital syphilis cases in the United States (U.S.), a nearly twofold increase in cases since 2014. This study assessed gaps in preventing congenital syphilis in the high morbidity region of Kern County, California.MethodsBetween May 2018 and January 2019, we conducted five focus group discussions with pregnant/postpartum women and ten semi-structured interviews with prenatal care providers in Kern County. Focus group and interview data were recorded, transcribed, and analyzed to identify emergent themes pertaining to facilitators and barriers at each step (prenatal care, syphilis screening and treatment) in the congenital syphilis prevention cascade.ResultsGaps in congenital syphilis prevention discussed in focus group discussions with pregnant/postpartum women were related to limited prenatal care access, social-, economic-, and cultural-barriers, and substance use and co-occurring intimate partner/domestic violence. The gaps identified from interviews with prenatal care providers included social economic vulnerabilities of pregnant women and stigma and shame around the vulnerabilities, distrust in medical system, prenatal substance use, limited prenatal substance use disorder treatment facilities, and inadequate provider training on context-specific congenital syphilis management strategies. Gaps in partner notification, screening and treatment for syphilis were brought up by pregnant/postpartum women and prenatal care providers.ConclusionsCongenital syphilis continues to increase in Kern County and throughout the U.S. In high syphilis morbidity areas, comprehensive and tailored public health approaches addressing setting-specific gaps in prenatal screening and treatment are needed.

BackgroundCongenital syphilis (CS) has reemerged as a global maternal and child health crisis. Kern County, California and East Baton Rouge Parish, Louisiana are among the highest CS morbidity regions in the United States. We previously reported on social-ecological and structural barriers to prenatal care and maternal syphilis testing and treatment in these two regions. The aim of this study was to examine perinatal patient's health preferences and perceptions of patient-provider relationships in the prenatal care clinic setting.MethodsBetween May 2018 and January 2019 we conducted 20 in-depth qualitative interviews with prenatal providers and 8 focus group discussions with pregnant and postpartum individuals in Kern County and East Baton Rouge Parish. We applied an adapted health services framework to analyze participants' understanding of health disparities and vulnerable populations; perinatal patient's health and prenatal care preferences; and participants' perspectives of clinical encounters in the context of prenatal care and maternal syphilis testing and treatment.ResultsSite-specific determinants of syphilis infection emerged but participants from both locations felt CS prevention efforts should be prioritized among youth, racial/ethnic minority populations, people experiencing socioeconomic limitations and people with other commonly occurring health conditions. Although perinatal patients expressed clear health preferences, they reported inconsistent receipt of respectful, patient-centered care. Inconsistencies were connected with limited ethnic and cultural competence among providers, and implicit, negative attitudes toward patients using substances, experiencing homelessness, or engaging in sex work. Providers clearly aimed to offer high quality prenatal care. However, some clinic and health systems level factors were thought to reduce positive and communicative patient-provider relationships, contributing to gaps in use of prenatal care and syphilis testing and treatment.ConclusionsOur findings suggest that interventions tailored to address setting-specific determinants (including clinic and health system factors) of disparities in CS risk could improve pregnant people's access to prenatal care and ensure they and their sex partners receive timely syphilis screening and treatment. We recommend all prenatal care providers receive training on how to identify and mitigate implicit biases and provide competent and compassionate patient-centered care.

Campus-based sexual violence and sexual harassment (SVSH) are prevalent issues that impact students detrimentally. Guided by community-based participatory research, this qualitative study assessed undergraduate students' perceptions of available campus SVSH resources, gaps in services, and recommendations for solutions for SVSH at three universities in California via interviews and focus groups. Approximately half of participants were unaware of available SVSH services, while others had varying knowledge of service availability and experiences with services. Students want better-funded, trauma-informed, and survivor-centered services and providers who share their identities and lived experiences. We provide multi-level student-centered solutions to improve current campus-based SVSH prevention efforts.

Research has found associations between intercollegiate athletics and risk for sexual violence, and that sexual violence is more pervasive at colleges and universities with National Collegiate Athletic Association (NCAA) Division I athletic programs, relative to NCAA Division II, NCAA Division III and no athletic programs. Simultaneously, sports involvement is linked with prosocial values and there are documented developmental benefits of sports participation. College athletic programs hold promise for fostering sexual violence prevention but there is limited knowledge about how student-athletes conceptualize sexual violence and how athletes, coaches, and administrators perceive available prevention and response programs. We conducted seven Focus Group Discussions (FGDs) and 21 In-Depth Interviews (IDIs) with student-athletes, athletic directors, and coaches from public university Division I (n = 2) and Division II (n = 1) campuses. We assessed perceptions of sexual violence, knowledge and opinions of available prevention and response programs, and sought input on how to bridge gaps in campus sexual violence policies. Student-athletes associated sexual violence with alcohol in their relationships with peers and asymmetrical power dynamics in relationships with coaches and faculty. Athletes felt strong connections with teammates and sports programs but isolated from the larger campus. This created barriers to students' use of services and the likelihood of reporting sexual violence. Athletes felt the mandatory sexual violence prevention training, including additional NCAA components, were ineffective and offered to protect the university and its athletic programs from legal complications or cultural ridicule. Athletic staff were aware of policies and programs for reporting and referring sexual violence cases but their knowledge on how these served students was limited. Student-athletes were uncomfortable disclosing information regarding relationships and sexual violence to coaches and preferred peer-led prevention approaches.

Evidence-based programs are needed to engage men and boys that encourage the transformation of concepts of masculinity that uphold patterns of intimate partner violence (IPV). This study explores the constructs of masculinity and male gender norms surrounding sexual attitudes and IPV among men and boys living in Rakai, Uganda. Between April and August 2017, we conducted 38 interviews and 5 focus group discussions with men and boys aged 15 to 49 years and 4 focus groups with key stakeholders to understand how male use of violence is influenced by personal, community, and society-level concepts of masculinity. We adapted 2 constructs of masculinities, reputation and respectability, in the analysis to examine masculinities in relation to IPV in the rural Ugandan setting. Findings suggest men and boys upheld 2 types of masculinities: respectability versus reputation. Masculine attributes related to respectability (referred to as "responsible men") included having a job, house, wife, and many children and taking care of family. Masculine attributes related to reputation (referred to as "cool men") included having sexual prowess, multiple sexual partners, and the resources to buy nice things. Both masculine norms were used to justify dominance over women and IPV. The divergence of masculinity was observed among youth and young adults who participated in a gender-transformative program, suggesting the effectiveness of the program. The gender-transformative approach should provide men and boys a chance to reflect on dynamic, often conflicting, images of a man and should empower individuals to renegotiate and reconceptualize masculine norms. This critical reflection on masculinity, which resonates with men and boys, needs to be included when engaging men within HIV and IPV prevention programs.

Congenital syphilis is the result of placental transmission from mother to fetus of Treponema pallidum. Although congenital syphilis is preventable through timely treatment, the rate of new infections in the United States (US) has increased each year since 2013, and is increasing at a noticeably greater pace in California (CA). Most research into congenital syphilis has focused on individual psychosocial and behavioral factors that contribute to maternal vulnerability for syphilis. The aim of this study was to evaluate structural barriers to prenatal care access and utilization and congenital syphilis prevention in Kern County, CA. Transcripts from 8 in-depth interviews with prenatal care providers and 5 focus group discussions with 42 pregnant and postpartum persons were examined using thematic analysis. Structural barriers experienced by pregnant and postpartum persons to prenatal care access and utilization included (1) burdens of poverty; (2) stigma around substance use in pregnancy; (3) citizenship status; (4) lack of healthcare coverage; (5) low sexual health literacy; and (6) gender inequality Structural barriers experienced by prenatal care providers in congenital syphilis prevention included (1) limited guidance on clinical management of syphilis in pregnancy; (2) decay in public health infrastructure; and (3) inadequate support for managing patients' social comorbidities. The response to congenital syphilis prevention will require an examination of the complex context of social determinants of health in which persons diagnosed with syphilis live in.

Since the introduction of antiretroviral therapy, the number of women living with HIV (WLHIV) continues to increase. Despite the decrease in HIV diagnosis among women in California, less than half of WLHIV are retained in HIV care. Structural barriers put women at increased risk for delayed HIV diagnosis, delayed entry into HIV care, and poorer treatment outcomes. The objective of this qualitative analysis is to identify how structural barriers negatively impact women's sustained engagement in HIV care in Southern California. WLHIV accessing local HIV support services participated in a qualitative study by completing a semi-structured interview and brief survey between January and April 2015 (n = 30). Poverty, unemployment, housing instability, and needs for transportation emerged as the dominant structural barriers for women when discussing their challenges with sustained engagement in HIV care. System-level interventions that decrease these noted barriers may help improve HIV care continuum for women living in Southern California.

Multidimensional causes of insufficient sleep among adolescents are not fully explored, particularly, the association between substance use and sleep duration. The 2017 Youth Risk Behavior Surveillance System (YRBSS) of high school students (N = 14,638; 51% female, 14-18 years old) was used to examine the association between substance use, namely cigarette, electronic vapor, alcohol, and marijuana use in the past 30 days, and insufficient sleep (<8 hr) using logistic regression analyses. Findings suggest that the use of alcohol (adjusted odds ratio [AOR], 1.42; 95% CI [1.22, 1.65]) and marijuana (AOR, 1.19; 95% CI [1.00, 1.41]) was significantly associated with having insufficient hours of sleep adjusting for age, sex, race, and computer use [greater than or equal to]3 hr per day. Moreover, interaction effects were examined for sex and age, which revealed that the association between marijuana use and having insufficient sleep was stronger for male and younger students. It highlights the potential value of sleep assessment among adolescent substance users.

IntroductionUganda has one of the highest rates of alcohol use in sub-Saharan Africa but prevalence and correlates of drinking are undocumented in the Rakai region, one of the earliest epicenters of the HIV/AIDS epidemic in East Africa.MethodsWe analyzed cross-sectional data from 18,700 persons (8,690 men, 10,010 women) aged 15-49 years, living in agrarian, trading and fishing communities and participating in the Rakai Community Cohort Study (RCCS) between March 2015 and September 2016. Logistic regression models assessed associations between past year alcohol use and sociodemographic characteristics, other drug use and HIV status, controlling for age, religion, education, occupation, marital status, and household socioeconomic status.ResultsPast year alcohol prevalence was 45%. Odds of drinking were significantly higher in men (versus women) and fishing communities (versus agrarian areas). Odds of drinking increased with age, previous (versus current) marriage and past year drug use. By occupation, highest odds of drinking were among fishermen and (in women) bar/restaurant workers. Alcohol-related consequences were more commonly reported by male (vs. females) drinkers, among whom up to 35% reported alcohol dependence symptoms (e.g., unsteady gait). HIV status was strongly associated with alcohol use in unadjusted but not adjusted models.ConclusionsAlcohol use differed by gender, community type and occupation. Being male, living in a fishing community and working as a fisherman or restaurant/bar worker (among women) were associated with higher odds of drinking. Alcohol reduction programs should be implemented in Uganda's fishing communities and among people working in high risk occupations (e.g., fishermen and restaurant/bar workers).

This study purpose was to investigate sex differences in multilevel factors associated with smoking experimentation and age of initiation among Korean adolescents. Based on the ecological model, this cross-sectional study used data from the 2016 Korea Youth Risk Behavior Web-Based Survey (N = 65,528). Among 33,803 males (51.6%) and 31,725 females (48.4%), a greater proportion of males (21.9%) than females (7.1%) engaged in smoking experimentation. Males started smoking earlier than females (males: 12.7 years, females: 12.9 years, respectively, p <0.05). In both sex groups, common factors associated with smoking were age, depression, suicidal ideation, academic achievement, household economic status, and having friends smoking and a specific person to talk with about their personal concern (all p values <0.05). There were significant sex differences in psychological, family, and school factors of smoking initiation and experimentation. It is necessary to develop smoking interventions considering both individual and environmental factors with sex-specific strategies.

Fresh-cut romaine lettuce's high perishability challenges ready-to-eat (RTE) salad production. Selecting cultivars less prone to browning and decay is crucial for extending shelf life. Traditional quality evaluation methods using instrumentation and trained panelists are time-consuming and logistically complex. This study investigated the effectiveness of untrained volunteers in assessing fresh-cut romaine lettuce quality. Given that the average consumer in the USA is familiar with the flavor characteristics of romaine lettuce, this study proposed to investigate the value of having untrained volunteers discern the quality of fresh-cut romaine lettuce. Therefore, six romaine lettuce accessions (Green Forest, King Henry, Parris Island Cos, PI 491224, SM13-R2, and Sun Valley) were assessed for sensory quality attributes (browning, green color, decay, and overall quality) and compared with instrumentation analyses (gas composition including O2 and CO2, electrolyte leakage, and color). The results showed significant quality differences (p < 0.05) among the accessions, with some seasonal variability. Very importantly, the consumers' (n = 159) assessments revealed similar results to those produced by either instrumentation or a trained panel. The consumers provided sensory scores that allowed for the grouping of accessions based on their postharvest quality, which efficiently matched their pedigree relationship. In conclusion, ad hoc consumer panels can be an effective way to characterize the quality of romaine lettuce for RTE salads. [ABSTRACT FROM AUTHOR]

This article analyses the impact South Korean housewives exerted on Cold War‐era domesticity. It first traces the trans‐war trajectory of modern domesticity from Meiji Japan and its colonies through its Cold War manifestation, when America exerted hegemonic influence. Thereafter, this article examines the tactics that housewives employed to gain power within the domestic sphere and beyond: earning money, microfinance, labour and side‐line work, and an assertive response to the purse string debate in South Korea. The article also argues that even though prescriptive gender norms continued to inform the everyday lives of these housewives, their increasing bargaining power gave them economic authority to renegotiate and reimagine domesticity during the Cold War. [ABSTRACT FROM AUTHOR]

The popularity of ready-to-eat (RTE) salads has prompted novel technology to prolong the shelf life of their ingredients. Fresh-cut romaine lettuce is widely used in RTE salads; however, its tendency to quickly discolor continues to be a challenge for the industry. Selecting the ideal lettuce accessions for use in RTE salads is essential to ensure maximum shelf life, and it is critical to have a practical way to assess and compare the quality of multiple lettuce accessions that are being considered for use in fresh-cut applications. Thus, in this work we aimed to determine whether a computer vision system (CVS) composed of image acquisition, processing, and analysis could be effective to detect visual quality differences among 16 accessions of fresh-cut romaine lettuce during postharvest storage. The CVS involved a post-capturing color correction, effective image segmentation, and calculation of a browning index, which was tested as a predictor of quality and shelf life of fresh-cut romaine lettuce. The results demonstrated that machine vision software can be implemented to replace or supplement the scoring of a trained panel and instrumental quality measurements. Overall visual quality, a key sensory parameter that determines food preferences and consumer behavior, was highly correlated with the browning index, with a Pearson correlation coefficient of −0.85. Other important sensory decision parameters were also strongly or moderately correlated with the browning index, with Pearson correlation coefficients of −0.84 for freshness, 0.79 for off odor, and 0.57 for browning. The ranking of the accessions according to quality acceptability from the sensory evaluation produced a similar pattern to those obtained with the CVS. This study revealed that multiple lettuce accessions can be effectively benchmarked for their performance as fresh-cut sources via a CVS-based method. Future opportunities and challenges in using machine vision image processing to predict consumer preferences for RTE salad greens is also discussed. [ABSTRACT FROM AUTHOR]