Recent publications
Introduction
Cocreation, a collaborative process of key interested partners working alongside researchers, is fundamental to community-engaged research. However, the field of community-engaged research is currently grappling with a significant gap: the lack of a pragmatic and validated measure to assess the quality of this process. This protocol addresses this significant gap by developing and testing a pragmatic cocreation measure with diverse community and research partners involved in participatory health-related research. A valid measure for evaluating the quality of the cocreation process can significantly promote inclusive research practices and outcomes.
Methods and analysis
The measure consists of two components: (1) an iterative group assessment to prioritise cocreation principles and identify specific activities for achieving those principles and (2) a survey assessing individual partner experience. An expert panel of 16–20 patients, community, healthcare providers and research partners, will participate in a modified Delphi process to assist in construct delineation and assess content validity using group discussions and rating exercises. We will compute survey items using an Item-Level Content Validity Index and a modified kappa statistic to adjust for chance agreement with panel members’ ratings. We will then conduct cognitive interviews with a new group of 40 participants to assess survey item comprehension and interpretation, applying an iterative coding process to analyse the data. Finally, we will assess the measure’s psychometric and pragmatic characteristics with a convenience sample of 300 participants and use the Psychometric and Pragmatic Evidence Rating Scale. Construct validity will be assessed by examining survey data using confirmatory and exploratory factor analysis.
Ethics and dissemination
This funded study (years 2024–2025) has been approved by the Institutional Review Board at the University of Colorado, Denver. The team will share the study findings online, with key partners, and by publishing results in a peer-reviewed journal.
Background
Setting rules about alcohol use and minimizing its availability in the home are known effective parent‐level strategies for reducing underage drinking risk. However, parents' restrictions and their perceptions of their child's alcohol access have rarely been considered in combination (e.g., determining if rule‐setting consistently accompanies perceived easy access), despite the potential to inform targeted prevention. The current study identified patterns in six parent‐reported indicators of their child's alcohol restrictions and access and characterized them with respect to race/ethnicity, socioeconomic status, community type (urban, suburban, or rural), and neighborhood (dis)advantage.
Methods
Latent profile analysis was applied to Follow‐up Year 2 data from the parents of Black, Latinx, and White participants in the Adolescent Brain Cognitive Development Study (n = 9586; youth mean age = 12.05; 47.50% girl, 51.32% boy, 0.32% other gender; 14.29% Black, 25.97% Latinx, and 59.74% White) to derive distinct profiles.
Results
Four profiles (subgroups) emerged: High Restrictions/No Drinkers in Household (32.18%), Low Restrictions/High Access (29.58%), High Restrictions/High Access (26.38%), and High Restrictions/Low Access (11.86%). Black and Latinx youth and parents with relatively low educational attainment and income were overrepresented in the High Restrictions/No Drinkers in Household and High Restrictions/Low Access subgroups. By contrast, the low restrictions subgroups were composed primarily of parents of White youth living in advantaged neighborhoods.
Conclusions
Findings support the notion that parents' perspectives and behaviors around youth alcohol access cannot be divided simply into restrictive and permissive. Further, the observed differences by demographic and neighborhood factors suggest the value of tailoring parent‐level prevention approaches to consider community norms.
Background
Cannabis use and alcohol use are associated with self-harm injuries, but little research has assessed links between recreational cannabis outlet openings on rates of self-harm within communities or the interactions of cannabis outlets with the density of alcohol outlets. We estimated the associations of recreational cannabis outlets, alcohol outlets, and their interaction on rates of fatal and nonfatal self-harm injuries in California, 2017-2019.
Methods
Using California statewide data on recreational cannabis outlets, alcohol outlets, and hospital discharges and deaths due to self-harm injuries, we conducted Bayesian spatiotemporal analyses of quarterly ZIP code-level data over 3 years, accounting for confounders and spatial autocorrelation. Using the model posteriors, we estimated parameters corresponding to hypothetical shifts in outlet densities.
Results
If recreational cannabis outlets had never opened, we estimated that nonfatal self-harm injuries would have been -0.35 per 100,000 lower (95% credible interval: -1.25, 0.51), while fatal self-harm injuries would have been -0.004 per 100,000 lower (95%CI: -0.26, 0.25). These associations did not depend on alcohol outlet density, but a hypothetical 20% reduction in alcohol outlet densities was associated with fewer self-harm injuries (RD per 100,000, nonfatal: -1.59; 95%CI: -2.60, -0.59; fatal: -0.10; 95%CI: -0.37, 0.16). Associations for nonfatal incidents were strongest for people aged 15-34 years, and White and Hispanic people.
Conclusion
We did not find evidence that the introduction of recreational cannabis outlets was associated with self-harm injuries or that cannabis and alcohol outlet densities interact, but alcohol outlet density had a strong association with nonfatal self-harm injuries.
Background
This study examines whether state‐level alcohol policy types in the United States relate to substance use disorder treatment admissions and birth outcomes among young pregnant and birthing people.
Methods
We used data from the Treatment Episode Data Set: Admissions (TEDS‐A) and Vital Statistics birth data for 1992–2019. We examined 16 state‐level policies, grouped into three types: youth‐specific, general population, and pregnancy‐specific alcohol policies. Using Poisson and logistic regression, we assessed policy effects for those under 21 (aged 15–20) and considered whether effects differed for those just over 21 (aged 21–24).
Results
Youth‐specific policies were not associated with treatment admissions or preterm birth. There were statistically significant associations between family exceptions to minimum legal drinking age (MLDA) policies and low birthweight, but findings were in opposite directions across possession‐focused and consumption‐focused (MLDA) policies and did not differentially apply to people 15–20 versus 21–24. Most pregnancy‐specific policies were not associated with treatment admissions, and none were significantly associated with birth outcomes. A few general population policies were associated with improved birth outcomes and/or increased treatment admissions. Specifically, both government spirits monopolies and prohibitions of spirits and heavy beer sales in gas stations were associated with decreased low birthweight among people 15–20 and among people 21–24. Effects of Blood Alcohol Concentration (BAC) limits varied by age, with slight reductions in adverse birth outcomes among people 15–20, as BAC limits get stronger, but slight increases for those 21–24. Although treatment admissions rates across ages were similar when BAC limits were in place, treatment admissions were greater for pregnant people 21–24 than for 15–20 when there were no BAC limits.
Conclusions
General population policies also appear effective for reducing the adverse effects of drinking during pregnancy for young people, including those under 21. Policies that target people based on age or pregnancy status appear less effective.
Synopsis
Kenyan adolescent girls and young women with a history of pregnancy experience poor psychological well‐being, highlighting the need for targeted interventions for this vulnerable demographic.
Background
School-based health centers (SBHCs) provide vital behavioral, sexual, and reproductive healthcare services to school-aged youth across the United States. Adolescents who are sexual and gender diverse (SGD) are far more likely to suffer from adverse health outcomes than their cisgender and heterosexual peers. Emerging structural competency frameworks call for cultivating capacities in SBHCs to modify organizational service delivery environments, including provider and staff knowledge and behaviors, to influence SGD adolescent well-being. Nationally recognized guidelines for nurturing structural competency include (1) adopting, disseminating, and adhering to SGD supportive policies and procedures; (2) creating welcoming physical environments; (3) systematically documenting and using sexual orientation and gender identity information in clinical care; (4) training all employees in best practices for interacting with SGD patients; and (5) developing the clinical workforce to deliver high-quality services to SGD patients. This community-engaged study will test the effectiveness of the Dynamic Adaptation Process (DAP) in implementing these guidelines in SBHCs in culturally and geographically diverse areas of New Mexico.
Methods
We will conduct mixed-method readiness assessments to identify inner- and outer-context determinants affecting the implementation of structurally competent changes in SBHCs; employ a stepped-wedge trial to examine how the DAP-enabled implementation impacts adoption and changes in SBHC, student (patient), and implementation outcomes; and investigate inner- and outer-context determinants, bridging factors, and associated mediators and moderators influencing implementation processes and outcomes related to guideline adoption and SGD student care (e.g., reduced barriers, greater satisfaction and engagement).
Discussion
This study addresses the long-term goal of high-quality care and decreased health disparities for SGD youth. As investments in SBHCs rise nationwide, opportunities to enhance services for SGD youth will also grow. This study will demonstrate the usefulness of a multifaceted implementation strategy, the DAP, in helping SBHCs build structural competency to serve a sizeable population of students affected by stigmatization, discrimination, and other social forces that create inequities in health. Accordingly, we will advance a model featuring a set of implementation strategies to reduce knowledge and practice gaps, create welcoming environments, and improve the quality of care for SGD youth.
Trial registration
ISRCTN13844475; 20 September 2024.
To identify factors in adolescence that predict the onset of sexual violence in adolescence and young adulthood. Data were analyzed from six survey waves of the longitudinal Growing up with Media Study (2008–2018) conducted in the USA. Participants were 778 youth 13–18 years old at baseline, who completed online surveys assessing sexual violence behaviors and predictors. Sexual violence perpetration behaviors included sexual assault, rape, attempted rape, and coercive sex. Only 2% of females and 3% of males reported their first sexual violence perpetration by age 14. In contrast, by age 18, 6% of females and 12% of males had perpetrated their first sexual violence. For both males and females, the rate of the onset seems to plateau by age 22. Predictors of the onset of sexually violent behavior for those who began perpetrating when they were 14–17 years old were largely similar to those who began perpetrating when they were 18–25 years old. Alcohol plus other substance use, aggressive and delinquent behavior, caregiver monitoring, behavior problems at school, externalizing peers, exposure to community violence, and exposure to violent media were all implicated. Early prevention—well before college and perhaps even before high school—is needed to have an impact on the onset of sexual violence perpetration, as most perpetrators of sexual violence will have acted for the first time by age 23. Several modifiable risk factors observed in adolescence could signal the opportunity for targeted prevention to reduce the odds of onset of sexual violence.
Background
Amidst a national surge in overdose deaths among racial and ethnic minoritized people and people who use stimulants (cocaine or methamphetamines), our objective was to understand how these groups are adapting to a rapidly changing illicit drug supply.
Methods
We conducted semi-structured interviews with 64 people who use drugs and who self-identified as Black, Hispanic, Multiracial, or other Non-White race in three states (Michigan, New Jersey, and Wisconsin). Transcribed interviews were coded thematically.
Results
Most respondents used stimulants alone or in combination with opioids. Respondents perceived that the drug supply had become more unpredictable and dangerous but differed in their personal perception of risk and their adaptations. For example, respondents had very mixed perceptions of their own risk of being harmed by fentanyl, and differing opinions about whether fentanyl test strips would be useful. Xylazine, a novel adulterant in the opioid drug supply that has received public health and media attention, was not well known within the sample.
Conclusion
Our study highlights the challenges experienced by minoritized people who use drugs in responding to a changing drug supply, underscoring the limits of public health approaches focused solely on individual behavioral change.
Background
Alcohol pricing policies can reduce population‐level alcohol consumption. To inform these policies, it is essential to understand the price per standard alcoholic drink of the least expensive brands. This study focused on prices of ready‐to‐drink products because of their accessibility, popularity among young people, and market expansion in recent years.
Methods
In 2023, we systematically identified 39 retail stores selling alcohol online in Fort Worth, Texas. For each product, we recorded information regarding brand name, alcohol‐by‐volume (abv), liquid volume, and price (n = 10,818). Ready‐to‐drink products encompassed beer, malt liquor, cider, premixed cocktails, and flavored alcoholic beverages (FAB) including hard beverages (seltzer, soda, tea, lemonade), excluding wine and distilled spirits. We limited analyses to brands sold by at least three stores and deduplicated products within stores. Our analytic sample size was 3924.
Results
The least expensive brands included the following: Four Loko, MXD Drinks Co., Steel Reserve (High Gravity Lager and Alloy Series), Hurricane High Gravity, Natural Ice, Natty Daddy, Clubtails, Sauza Agave Cocktails, Truly Extra, and Icehouse. The average abv among all products was 5.9%. Among the 20 least expensive brands, the average abv was 9.0%, and 70% were available in single‐serve containers.
Conclusions
The least expensive brands of ready‐to‐drink alcohol products were often high abv, single‐serve containers of FAB, malt liquor, or beer. Retail price assessments can strengthen the case for policy solutions, such as targeted taxes and re‐classification of products, to reduce the risks posed by low‐priced alcohol. The current study identifies some brands these retail assessments should include.
Purpose: Lesbian, gay, bisexual, and questioning (LGBQ) high schoolers experience high prevalence of poor behavioral health, but little is known about LGBQ middle schoolers. We sought to quantify behavioral health disparities of LGBQ middle school students. Methods: Using 2021 New Mexico Middle School Youth Risk and Resiliency Survey data (N = 12,400), we estimated the size of the LGBQ middle school population and calculated adjusted risk ratios to investigate behavioral health disparities between LGBQ and heterosexual youth. Results: A quarter of the sample identified as LGBQ. These youth reported significantly more suicidal behaviors and poorer mental health than heterosexual youth. LGBQ youth were more likely to use most substances compared with heterosexual youth. Conclusion: LGBQ middle school students demonstrated high prevalence of poor behavioral health. These findings show that disparities begin earlier than previously assumed and underscore that sociocultural landscapes for sexually diverse youth remain challenging.
Background
Prior research has shown that early alcohol experiences, such as age of initiation and speed of progression between drinking milestones, vary across racial/ethnic groups. To inform culturally tailored prevention efforts, this longitudinal study examined racial/ethnic differences in the associations of drinking firsts at home and with parental knowledge with alcohol use outcomes among underage youth.
Methods
The study included baseline and five follow‐up surveys, collected every 6 months, from California adolescents (ages 12–16 years at baseline). The analytic sample was composed of the 689 adolescents who reported lifetime alcohol use at baseline or a follow‐up survey (5% Black, 37% Latinx, 46% White, and 12% other/mixed racial/ethnic group; 54% female). Participants who reported consumption of a full drink, intoxication, or heavy episodic drinking (HED) were asked ages and contexts of these drinking firsts, including whether the initiation was at their own home and whether their parents/guardians knew about this drinking event. Outcomes included past‐6‐month alcohol frequency, alcohol quantity, and number of alcohol‐related problems. Multilevel negative binomial regression analyses were conducted, controlling for demographics and age of initiation by type of drinking behavior. Moderation analyses examined racial/ethnic differences.
Results
For consumption of the first full drink, both drinking at home and parental knowledge were negatively associated with all outcomes; associations did not vary by race/ethnicity. First intoxication at own home was negatively associated with the number of drinks for Latinx youth and with the number of problems for Black youth. For first HED, drinking at own home was positively associated with drinking frequency across groups, and for Black youth specifically, parental knowledge of their first HED experience was significantly associated with greater later alcohol frequency and quantity.
Conclusions
Results suggest that the association of family contexts of drinking first with later alcohol outcomes among underage youth varied by stage of alcohol use and race/ethnicity.
Introduction
Low- and middle-income countries bear disproportionate burdens from excessive alcohol consumption, yet have fewer resources to identify and intervene with risky drinkers. Low-cost screening and brief intervention (SBI) models offer a tool for addressing this health problem and reducing disparities.
Methods
In this mixed-methods study, trained pseudo-patients visited health clinics in Zacatecas, Mexico, where a novel SBI model was used with trained nonmedical health educators (HEs) conducting SBI in waiting areas. Pseudo-patients, who provided responses to the AUDIT-C screening items designed to trigger a brief intervention (BI), waited for HEs to engage them in an SBI encounter. Data on HEs’ behaviors, SBI components provided, and contextual characteristics were coded from audio recordings of the encounters using an SBI checklist and from pseudo-patient interviews.
Results
Quantitative analyses examined the consistency in pseudo-patients’ targeted AUDIT-C scores and those documented by HEs as well as the frequency of delivery of SBI components. Across 71 interactions, kappas between HEs’ scores and the targeted AUDIT-C scores ranged from 0.33 to 0.45 across AUDIT-C items; it was 0.16 for the total AUDIT-C. In 41% of interactions, the HEs recorded total AUDIT-C scores that accurately reflected the targeted scores, 45% were below, and 14% exceeded them. Analyses of checklist items and transcripts showed that HEs demonstrated desired interpersonal skills (attentive, empathetic, professional) and provided general information regarding risks and recommendations about reducing consumption. In contrast, personalized BI components (exploring pseudo-patients’ personal challenges and concerns about reducing drinking; making a plan) occurred much less frequently. Pseudo-patient interviews revealed contextual factors (noise, lack of privacy) that may have negatively affected SBI interactions.
Discussion
Using trained nonmedical persons to administer SBI holds promise to increase its reach. However, ongoing training and monitoring, prioritizing comprehensive BIs, eliminating contextual barriers, and electronic delivery of screening may help ensure high quality delivery.
Problem gambling in adolescence can lead to significant negative consequences, yet few studies have examined the prevalence and risk factors among diverse youth populations. This study investigated gambling and related non-gambling activities and sociodemographic correlates of problem gambling in 2,533 high-school students in New Mexico aged 12–18 years (mean age 15.6), with an approximately equal gender distribution (49.3% male, 49.3% female,1.4% unspecified). Overall, 3% screened positive for problem gambling, with higher rates among males (3.9%) than females (2.1%),Native American (4.5%), and Hispanic (3.3%) versus white (1.5%)students. In-person activities were more common than online activities for both gambling and non-gambling activities. Substance use behaviors, including binge drinking, e-cigarette, marijuana, and prescription painkiller use, were more prevalent among people with gambling problems. Controlling for demographics, the interaction between Hispanic ethnicity and past 30-day binge drinking was positively associated with problem gambling. A risk score combining substance use and housing instability also positively predicted problem gambling. These findings demonstrate sociodemographic and substance use risk factors for problem gambling among New Mexico adolescents. The study highlights the importance of considering diverse ethnic backgrounds and co-occurring risk behaviors in developing targeted prevention and intervention strategies for adolescent problem gambling across various cultural contexts.
Mathematical modelling has played an increasingly prominent role in public health responses, for example by offering estimates of how infectious disease incidence over time may be affected by the adoption of certain policies and interventions. In this paper, we call for greater research and reflection into the ethics of mathematical modeling in public health. First, we present some promising ways of framing the ethics of mathematical modeling that have been offered in the very few publications specifically devoted to this subject. Second, to draw out some issues that have not yet been sufficiently considered, we bring in the case of mathematical modeling in voluntary medical male circumcision (VMMC) initiatives for HIV prevention in Africa. We argue that greater attention should be paid to ethical considerations in mathematical modeling, particularly as its use is becoming more widespread and its potential impacts are becoming greater in the ‘big data’ era, as witnessed during the COVID-19 pandemic.
Purpose
To test the assumption that person-first language (PFL) reduces obesity stigma, mediated by perceived personal responsibility for obesity.
Design
Cross-sectional, experimental.
Setting
Online, United States.
Participants
299 young adults.
Measures
Participants read a vignette using PFL or identity-first language (IFL) or about someone without obesity. Participants reported perceived personal responsibility for obesity, and 3 operationalizations of obesity stigma: prejudice, stereotypes, and support for punitive policies. Mediation analyses were used to test if the manipulation affected obesity stigma, through perceived personal responsibility.
Results
There was no indirect effect of PFL vs IFL on the 3 outcomes (95% CIs contained zero). However, the indirect effects of PFL vs no-obesity condition were significant (prejudice: β = −0.10, SE = 0.05, 95% CI [−0.22, −0.01]; stereotypes: ( β = 0.07, SE = 0.03, 95% CI [0.01, 0.14]); punitive punishment: ( β = −0.06, SE = 0.04, 95% CI [−0.15, −0.01]). Also, the indirect effects of IFL vs no-obesity condition on stereotypes ( β = 0.07, SE = 0.04, 95% CI [0.0003, 0.15]) and punitive punishment ( β = −0.06, SE = 0.04, 95% CI [−0.15, −0.0002]) were significant.
Conclusion
PFL may not affect obesity stigma as it does in the context of other marginalized groups. The effect of PFL and IFL, compared to the no-obesity condition, suggests future routes for intervention.
Recreational cannabis outlets may influence rates of interpersonal violence, but research has yielded inconsistent findings. Modification by alcohol outlet density may help explain inconsistencies. We estimated the impacts of recreational cannabis outlets on neighborhood-level assault injury rates in California and evaluated whether alcohol outlet density moderated these associations. We applied Bayesian spatiotemporal analyses to ZIP code-level statewide data on alcohol outlets, recreational cannabis outlets, and injuries and deaths due to firearm and nonfirearm assault, 2017-2019, accounting for confounders and spatial autocorrelation. Using the model posteriors, we estimated parameters corresponding to hypothetical shifts in outlet densities, overall and by age, sex, and race/ethnicity. If recreational cannabis outlets were never introduced, we estimated that nonfirearm assault injuries would have been 1.63 per 100,000 lower (95%CI: -3.08, 0.01) but we observed no association with firearm assault injuries (RD per 100,000: -0.07; 95%CI: -0.34, 0.21). These associations did not depend on alcohol outlet density, but a hypothetical 20% reduction in alcohol outlet densities was associated with fewer firearm (RD per 100,000: -1.89; 95%CI: -0.46, 0.09) and nonfirearm (RD per 100,000: -5.67; 95%CI: -7.44, -3.95) assault injuries. The introduction of recreational cannabis outlets may have contributed to a small increase in nonfirearm assault injuries.
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