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Introduction Transportation workers are at risk for obstructive sleep apnea (OSA), yet OSA is commonly undiagnosed in this population. In a two-phase study, we design and evaluate a tailored, mobile health (mHealth) intervention aimed at achieving OSA awareness, including changes in OSA beliefs, among operators of large highway maintenance vehicles. Methods In Phase 1, we recruited highway maintenance vehicle operators employed at worksites in the US northeast for focus groups to examine OSA beliefs and barriers. Results of the Phase 1 focus groups were used to inform the tailored intervention. In Phase 2, we evaluated the tailored approach, “Sleep Strong, Live Long,” in a mini-RCT. Worksites were randomized to intervention (Sleep Strong, Live Long) or control. Employees at both worksites completed baseline questionnaires and follow-up questionnaires 2-months post-baseline. Employees at the intervention worksite received a 30 minute in-person education session, access to an interactive website including video success stories, then follow-up text messages over 2 months as part of the Sleep Strong, Live Long program. The control condition received the intervention after completing follow-up surveys. We compared responses on the follow-up surveys between intervention and control conditions using linear regression with baseline responses as covariates. Results Phase 1 themes included common sleep complaints, inconsistent work schedules, and misconceptions about OSA (n=45). 75% of Phase 1 participants reported resistance to OSA behavior change. Phase 2 mini-RCT participants (n= 38) were on average 43.4 (sd=12.1) years old. Participants were 86.8% male and 67.6% reported an annual household income of $50,000 or more. Exposure to the intervention was associated with an improvement in OSA literacy (b=0.14, p=0.037), but not OSA self-efficacy (b=0.12, p=0.330) or OSA readiness to change (b=0.76, p=0.336). Conclusion We provide preliminary support for improving OSA literacy among a sample of transportation workers. Future research may evaluate the tailored program in a larger sample of workers and with a longer follow-up period to consider whether OSA literacy and self-efficacy mediate actual OSA behaviors, such as changes in OSA evaluation and treatment. Support (if any) This work was supported by the National Heart, Lung, and Blood Institute (NHLBI) at the National Institutes of Health (NIH, Grant # K01HL150339).

The purpose of the present study was to adapt and pilot a trauma-informed, mindfulness-based yoga (TIMBY) intervention focused on enhancing self-regulation among youth in the Georgia Department of Juvenile Justice system. In this article we (1) describe the process by which we systematically adapted an evidence-based protocol specifically for this population, (2) describe the nature of and rationale for those adaptations, (3) present some preliminary qualitative findings based on interviews with youth participants, and (4) briefly summarize how the adapted protocol will be evaluated in the subsequent feasibility trial. The iterative drafting and revision process involved modifications to a well-established, protocolized Trauma-Informed Yoga program and was identified by the project advisory board and t h rough formal interviews with intervention staff. Qualitative interviews were conducted with youth participants concerning intervention impact, credibility, and satisfaction. Several needed modifications were identified so that the intervention would be contextually appropriate for justice-involved youth. Thirty youth were enrolled in the pilot study: 77% we re Non - Hispanic Black/African-American, 18% were Non-Hispanic White, and 5% were Hispanic White. The average age was 16.45 years (range 14–20). The youth consistently reported satisfaction with the sessions and positive beliefs about how the sessions were helping them with a range of physical and psychological/ emotional challenges. Adaptations to the protocol in the present study highlight how mindfulness-based interventions for justice-involved youth need to consider what is both developmentally suitable for youth and appropriate in a justice setting. A feasibility study using this revised TIMBY protocol is underway at four Georgia Department of Juvenile Justice facilities to formally identify the barriers and facilitators to implementation for the present study and a future, larger-scale trial.

BACKGROUND Adolescents and young adults (AYA) aged younger than 25 years have the highest rates of sexually transmitted infections (STIs) in the United States. Current STI prevention strategies for AYA rely primarily on individual approaches, leaving sexual partners with significant unmet sexual and reproductive health care and health education needs. Dyadic interventions may hold promise for harnessing the power of communal coping within relationship dynamics to enhance sexual decision making, communication, and behavior changes that reduce the future risk of STIs. OBJECTIVE This paper describes the protocol and research methods of a dyad-based behavioral intervention that augments individual evidence-based interventions with joint health education counseling for heterosexual AYA dyads within a primary care setting. The trial aims to improve partner communication and collaborative sexual decision making and promote the adoption of sexual behaviors such as consistent condom use. The primary objective of this study is to assess the feasibility, acceptability, and effectiveness of a dyadic intervention targeted at preventing STIs in heterosexual couples in an urban setting. METHODS A total of 100 AYA (50 dyads) aged 16 to 25 years, engaged in heterosexual intercourse, who reside in the city and are willing to recruit their main sexual partner for the study will be recruited and randomized into 2 groups, an intervention arm and a control arm. Participants will be recruited from an AYA medicine clinic and by using social media (Facebook and Instagram). The index participant and partner will complete a single individual session separately (Sister to Sister or Focus on the Future) with a gender-matched health educator. Dyads will then be randomized to receive an additional joint debriefing session together to discuss relationship dynamics, condom negotiation, etc. Participants will separately complete a telephone interview 6 weeks postintervention to determine the feasibility, acceptability, and impact of the intervention on mutual sexual negotiation, consistency of condom use, and communal coping skills, etc. RESULTS So far, 25.4% (44/173) of eligible participants have been enrolled and randomized. Participants are mostly female (20/22, 91%), with at least a high school diploma (19/22, 86%), and 9 average lifetime sexual partners. Acceptability is high, with 98% (43/44) of participants expressing satisfaction with their study experience; 100% of dyads recruited were still together at 6-week follow-up. CONCLUSIONS Findings from this study will add to the current literature on the approaches to STI prevention, and its success will inform its application in risk reduction counseling for youth who are most at risk. CLINICALTRIAL Clinical Trials.gov NCT03275168; https://www.clinicaltrials.gov/ct2/history/NCT03275168 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/29389

Across cultures and belief systems, compassion is widely considered to be beneficial for the development of personal and social wellbeing. Research indicates that compassion-training programs have broad health benefits, but how and why compassion-training programs are effective is still relatively unknown. This paper describes the theoretical underpinnings of a specific compassion-training program, CBCT® (Cognitively-Based Compassion Training), and proposes an integrative model that draws on existing health behavior constructs to identify CBCT’s core components and hypothesizes their directionality and interaction. The model includes two primary categories of skill development: (1) intrapersonal skills leading to greater resiliency, and (2) interpersonal skills leading to greater compassion. It is hypothesized that these two pathways are mutually reinforcing and both contribute to greater wellbeing. This model provides a foundation for theory-driven research on the underlying mechanisms in CBCT training. An understanding of CBCT’s mechanisms is a critical step towards optimizing and personalizing the intervention to meet the needs of specific populations.

This study explored whether adolescents with elevated symptoms of mania (ESM+) engage in more HIV risk behaviors than those with other psychiatric disorders and examined factors associated with HIV risk behavior among ESM+ adolescents. Eight hundred forty adolescents (56% female, 58% African American, M age = 14.9 years) who received mental health treatment completed private, computer-based assessments of psychiatric disorders and of sexual and substance use behaviors and provided urine to screen for sexually transmitted infections (STI). Eighty-seven percent met criteria for a psychiatric disorder, and among these youth 21% were considered ESM+. Compared to those with other psychiatric disorders, ESM+ were more likely to be sexually active (61.6% vs. 53.6%), have multiple sexual partners (58.6% vs. 37.5%), have unprotected sex (38.4% vs. 28.0%), exchange sex for money (4.7% vs. 1.2%), and test positive for an STI (14.0% vs. 6.3%). Among ESM+ youth, sexual risk behaviors were primarily associated with individual factors (e.g., self-efficacy, impulsivity, and substance use) and varied depending on the type of sexual behavior (e.g., onset of sex, number of partners, and condom use). Adolescents with ESM should be regularly screened for sexual risk behaviors and receive HIV prevention skills. Efforts to increase self-efficacy for safer sex, reduce impulsivity, and decrease substance use may be effective targets for sexual risk reduction among adolescents with ESM.

In the United States, youth under age 25 account for nearly half of newly diagnosed sexually transmitted infections (STIs) annually, including HIV (CDC, 2005). Youth with psychiatric disorders or with a history of psychiatric hospitalizations initiate intercourse at an earlier age, are less likely to use condoms, have higher rates of STIs, have more unintended pregnancies, and have more sexual partners than adolescents without a history of mental illness (Baker & Mossman, 1991; DiClemente & Ponton, 1993; Valois, Bryant, Rivard, & Hinkle, 1997). The Social Personal Framework is a broad contextual model that posits the important role of personal attributes, peer /partner factors, family influences and the community in determining risk. It accounts for the increased risk among youth with psychiatric disorders by emphasizing the unique role of psychopathology (a personal attribute) because of its association with factors such as impulsivity, lack of judgment, cognitive misperception, sensitivity to partner rejection, sexual trauma and low self-esteem (Donenberg & Pao, 2005). Although psychopathology in general is associated with sexual risk, few studies have examined the relationship between groupings of disorders and risk. This project sought to extend previous research by documenting the additional risk associated with internalizing, externalizing, co-morbid disorders and Mania, compared to those adolescents who did not meet criteria but were in mental health treatment. Some psychiatric disorders may be more strongly associated with sexual risk than others because of differences in behaviors or attitudes (e.g., impulsivity associated with Conduct Disorder and ADHD; poor self-esteem associated with Depressive Disorders). Cross-sectional studies indicate that externalizing behaviors are linked with early sexual debut and failure to use condoms, and the association between internalizing behaviors and sexual risk behavior is inconsistent (Abrantes, Strong, Ramsey, Kazura, & Brown, 2006; Auslander et al., 2002; Donenberg, Bryant, Emerson, Wilson, & Pasch, 2003; Lehrer, Shrier, Gortmaker SL, & Buka, 2006; Lescano, Brown, Hadley, D'Eramo, & Zimskind, 2007; Mazzaferro et al., 2006; Rhode, Noell, Ochs, & Seeley, 2001; Shrier, Harris, Sternberg, & Beardslee, 2001; Waller et al., 2006). Some longitudinal studies suggest that symptoms of conduct disorder/antisocial behavior during childhood and adolescence are the best predictor of sexual risk behaviors during adulthood (Ramrakha et al., 2007). Other studies suggest that adolescent symptoms of anxiety, post-traumatic stress, and depression are predictive of sexual risk behavior as an adult (Stiffman, Dore, Earls, & Cunningham, 1992). We are not aware of any studies that have examined the association of Mania and sexual risk behavior in adolescents. Among adults, a history of Mania is consistently associated with sexual risk behavior, such as high rates of sexual activity, sex with prostitutes, and low rates of condom use (Meade, Graff, Griffin, & Weiss, 2008; Ramrakha, Caspi, Dickson, Moffitt, & Paul, 2000; Sacks, Dermatis, Burton, Hull, & Perry, 1994). Although Mania and Hypomania are not uncommon among adolescents, especially for youth in intensive treatment settings, the association with sexual risk behavior has not been rigorously examined. The current study used a structured computer interview to examine the relationship between psychiatric disorders (i.e., Major Depressive (MDD), Mania, Hypomania, Generalized Anxiety (GAD), Post Traumatic Stress (PTSD), Conduct (CD), Attention Deficit Hyperactivity (ADHD) and Oppositional Defiant Disorders (ODD)) and sexual risk behaviors. Adolescents meeting criteria were compared to adolescents who did not meet criteria but were in mental health treatment. This analysis accounts for the general factors associated with the need for treatment such as stress, impairment and family dysfunction. Factors, such as the presence of alcohol use and gender, could influence sexual risk and were assessed and adjusted for in tests of risk association. We hypothesized that a lifetime or recent occurrence of vaginal/anal sex, lack of condom use at last sex, number of partners and the presence of a STI would be associated with Mania and/or Hypomania and with disorders commonly thought of as externalizing disorders (CD, ODD, and ADHD) because of characteristic impulsivity and recklessness associated with these disorders (Brown, Lourie, Zlotnick, & Cohn, 2000). We did not have a priori hypotheses for internalizing disorders (MDD, GAD, and PTSD) and their relationships with sexual risk behavior because previous studies have yielded conflicting results.

Little is known about why some adolescents with internalizing symptoms engage in sexual behaviors that increase their risk for HIV. This study tested a mediation model of internalizing symptoms and safe sex intentions among adolescents receiving mental health treatment. Self-efficacy for HIV prevention, HIV knowledge, and worry about HIV were hypothesized to mediate associations between internalizing symptoms and safe sex intentions among sexually active and non-active adolescents receiving mental health treatment (N = 893, M age = 14.9). Significant indirect effects from internalizing symptoms to safe sex intentions varied according sexual experience: for sexually non-active adolescents, HIV worry and knowledge mediated this link, whereas for sexually active adolescents, HIV self-efficacy was the significant mediator. Increasing both HIV knowledge and self-efficacy for HIV prevention are important targets for HIV prevention with adolescents with internalizing symptoms, and careful attention should be paid towards targeting these interventions to sexually experienced and inexperienced youth.

To identify predictors of human papillomavirus (HPV) vaccination among rural African American families.Cross-sectional descriptive study in schools in three rural counties in southeastern United States. The sample consisted of African American parents or caregivers with children 9 to 13 years of age who attended elementary or middle school in 2010-2011.Using an anonymous, 26-item survey, we collected descriptive data during parent-teacher events from African American parents with children in elementary or middle school. The main outcome was measured as a response of "yes" to the statement "I have or will vaccinate my child with the HPV vaccine." In addition, composite scores of knowledge and positive attitudes and beliefs were compared. No interventions were conducted.We identified predictors of HPV vaccination and found that religious affiliation had a correlation with vaccinating or planning to vaccinate a child.Results indicate a need for further research on the role of local culture, including religion and faith, in rural African Americans' decisions about giving their children the HPV vaccination.This study emphasizes the importance of understanding rural African American parents' knowledge, attitudes, and spiritual beliefs when designing health education programs and public health interventions to increase HPV vaccination uptake among African American boys and girls living in rural areas.

BACKGROUND: The use of complementary and alternative medicine (CAM) among Human Immunodeficiency Virus (HIV)-positive individuals is becoming increasingly widespread. Unfortunately, some CAM therapies may jeopardize the efficacy of conventional HIV medication, making it critical to understand CAM use among this population. OBJECTIVE: To investigate the prevalence and predictors of CAM use in a theory-driven, multidimensional manner. METHODS: African-American individuals who had received a diagnosis of acquired immune deficiency syndrome (AIDS) were recruited. The computer-administered survey asked questions about participants' CAM use and various psychosocial and socio-demographic characteristics. Participants' most recent CD4+ cell counts and HIV RNA levels were abstracted from medical records. Linear regression analyses, adjusted for potential confounders, were conducted to assess the independent contribution of various factors in explaining frequency of CAM use. RESULTS: One hundred and eighty two subjects participated in the survey. Results indicate that most (94%) participants used at least one type of CAM therapy. The majority of participants (79.7%) used CAM therapies as a complement (rather than an alternative) to their HIV medications though half had not discussed these therapies with their healthcare providers. Female sex, high yearly income, high health literacy and high HIV RNA levels were associated with a greater frequency of CAM use, while stronger emotional well-being was associated with a lower frequency of CAM use. CONCLUSIONS: The implications of these findings are discussed and suggestions for future research are provided.

The present study sought to examine associations between maternal psychopathology, parental monitoring, and adolescent sexual activity among adolescents in mental health treatment. Seven hundred ninety mother-adolescent dyads recruited from adolescent mental health treatment settings completed audio computer-assisted structured interview assessments examining parent psychiatric symptoms, parental monitoring, and adolescent sexual risk behavior. Path analysis was used to examine the associations between variables of interest. Maternal caregivers who reported more mental health symptoms were more likely to have adolescents who reported recent sex and this relationship was mediated by less parental monitoring. These findings suggest that maternal caregivers with mental health symptoms may need specific interventions that provide assistance and support in monitoring their teens in order to reduce sexual risk taking among adolescents in mental health treatment.

Objective. We determined the association of demographic, psychosocial, and contextual factors with condom use among a large community sample of at-risk adolescents recruited from four locations in the U.S. Methods. We enrolled 1,410 adolescents/young adults between the ages of 15 and 21 with a history of unprotected sex in the past 90 days at four study sites. Subjects completed an audio-assisted, computerized assessment that gathered information about sexual behavior and its contexts, substance use, and relevant risk and protective attitudes. Results. Nearly two-thirds of adolescents did not use condoms at the time of last intercourse and adolescents reported a mean of 15.5 (median = 5) unprotected intercourse occasions in the past 90 days. Controlling for relevant demographic variables, not using condoms was associated with the perception that condoms reduce sexual pleasure, the perception that partners will not approve of condom use, and less discussion with partners about condoms. Conclusions. Even across racial/ethnic groups, gender, and geographic locations, several important correlates of adolescents' sexual risk reduction were identified. Many adolescents may feel that condoms reduce their sexual pleasure and fear partner reactions if they initiate condom use. These attitudes may be malleable through clinical and community-based interventions.

Authors examined if parental monitoring moderated effects of family sexual communication on sexual risk behavior among adolescents in psychiatric care. Seven hundred and eighteen parents reported upon quality of family discussions about sex-related topics and degree to which they monitor teen behavior. Adolescents reported the frequency of their own safe sex practices. Parental monitoring moderated the family communication quality–sexual risk behavior relationship among African American families. African American parents who perceived themselves as capable of open family sexual communication and frequent monitoring had adolescents who reported decreased sexual risk behavior. The moderator model was not supported among Caucasian and Hispanic families and findings did not depend upon gender. For African Americans, findings support the influential role of family processes in development of teen sexual risk behavior and suggest, for parents of teens receiving mental health services, learning communication and monitoring skills may be critical to their adolescent’s sexual health.

The authors compared the responses of 76 adolescents on an inpatient psychiatric service with those of 802 school-based adolescents in the same city regarding HIV risk behaviors. The psychiatrically hospitalized adolescents reported a significantly higher rate of sexual and drug-related behaviors that involve a risk for contracting sexually transmitted disease, including HIV-related illnesses.