J. Dennis Fortenberry’s research while affiliated with Indiana University School of Medicine - Lafayette and other places

Background Though social determinants are the primary drivers of health, few studies of people living with HIV focus on non-clinical correlates of insecure and/or fragmented connections with the care system. Our team uses linked clinical and multisector non‐clinical data to study how residential mobility and connection to social services influence the HIV care continuum. We engage a diverse group of individuals living with HIV and other invested community members to guide and inform this research. Our objective is to generate consultant-informed, research-based interventions that are relevant to the community, and to share our engagement approach and findings so that other researchers can do the same. Methods Our research team partnered with the Indiana Clinical and Translational Sciences Institute’s Research Jam to develop and implement a human-centered design research plan to engage individuals with experience relevant to our research. We recruited a panel of consultants composed of people living with HIV and/or clinicians and individuals from agencies that provide medical and non-medical services to people living with HIV in Marion County, Indiana. To date, we have used a variety of human-centered design tools and activities to engage individuals during six sessions, with results informing our future engagement and research activities. Results Since the inception of the project, 48 consultants have joined the panel. Thirty-five continue to be actively engaged and have participated in one or more of the six sessions conducted to date. Consultants have helped guide and prioritize analyses, aided in identification of data missing from our ecosystem, helped interpret results, provided feedback on future interventions, and co-presented with us at a local health equity conference. Conclusions We utilize community engagement to expand the scope of our research and find that the process provides value to both consultants and the research team. Human-centered design enhances this partnership by keeping it person-centered, developing empathy and trust between consultants and researchers, increasing consultant retention, and empowering consultants to collaborate meaningfully with the research team. The use of these methods is essential to conduct relevant, impactful, and sustainable research. We anticipate that these methods will be important for academic and public health researchers wishing to engage with and integrate the ideas of community consultants.

This cross-sectional study estimates the incidence of nonfatal firearm injuries among children and young adults after linking patient-level police and trauma registry data.

Background: Though social determinants are the primary drivers of health, few studies of people living with HIV (PLWH) focus on non‐clinical correlates of insecure and/or fragmented connections with the care system. Our team has used linked clinical and multisector non‐clinical data to study how residential mobility and connection to social services influence the HIV care continuum. We engage a diverse group of invested patients and community members to guide and inform this research. Our objective is to generate stakeholder-informed, research-based interventions that are relevant to the community, and to share our engagement approach and findings so that other researchers can do the same. Methods: Our research team partnered with the Indiana Clinical and Translational Sciences Institute’s Research Jam, to develop and implement a human‐centered design research plan to engage with individuals with lived experience relevant to our research. We recruited a panel composed of PLWH as well as clinicians and individuals from agencies that provide medical and non-medical services to PLWH in Marion County, Indiana. We used a variety of human-centered design tools and activities to engage individuals during six sessions, with results informing our engagement and research activities. Results: Since the inception of the project, 48 individuals have joined the stakeholder panel. Thirty-five are actively engaged and have participated in one or more of the six sessions conducted to date. The panel helped guide and prioritize analyses, aided in identification of data missing from our ecosystem, helped interpret results, provided feedback on future interventions, and co-presented with us at a local health equity conference. Conclusions: We utilized community engagement to expand the scope of our research and found that the process provided value to both stakeholders and research team members. Human-centered design enhanced this partnership by keeping it person-centered, developing empathy and trust, increasing stakeholder retention, and empowering stakeholders to collaborate meaningfully with the research team. The use of these methods is essential to conducting relevant, impactful, and sustainable research. We anticipate that these methods will be important for academic and public health researchers wishing to engage with and integrate the ideas of community stakeholders.

Background Adolescence is usually a period of normal and healthy sexuality development marked by experimentation and identity formation, but can also involve challenging experiences, particularly for sexual/gender minoritised young people. The concept of sexual wellbeing is useful in clarifying the links between sexuality and mental wellbeing, recognising that psychosocial issues like shame, stigma and trauma affect both sexuality and mental health. Sexual wellbeing demands focus beyond skills and competences to prevent risk of STIs and unintended pregnancy.Our conceptual model of young people’s sexual wellbeing takes a developmental perspective based on an existing model for adults which defines sexual wellbeing as ‘feeling safe, secure, respected, comfortable, and confident in relation to sexuality, and able to work through change, challenges, and negative past experiences’. It recognises that sexual wellbeing is influenced by environments, including family, peers, education, the health system, laws, and cultural values. Methods We conducted seven agenda-setting workshops with 28 young people aged 14 to 23 (mix of genders and sexual identities); 4 parents/carers; and 11 mental health researchers/practitioners. These workshops helped identify priority topics on links between adolescent sexuality and mental health. In March/April 2024 we will conduct six model-building workshops and 10 cognitive interviews with young people aged 14 to 19 years, to develop and refine a conceptual model and draft items for a corresponding measure. Results Agenda-setting workshops highlighted the following priorities among young people aged 14-23: body confidence; sexual pressures and expectations; confidence in own identities; access to community support; sexual shame; emotional impacts of first/previous experiences; expressing desires; and establishing boundaries. Our planned model-building workshops will uncover young people’s descriptions of ‘feeling good/feeling bad’ in the context of common developmental sexual experiences (e.g., from puberty, to exploring identity, learning about sex, exploratory activities, intended and unintended exposures to sexual content). Discussions will be structured around domains from an existing conceptual model for adults (rights and respect; self-esteem; comfort; safety; autonomy; self-efficacy; resources for support). In the final three workshops, we will co-produce a long-list of measure items to assess key issues. Ten cognitive interviews will probe comprehension, acceptability and appropriateness of terminology. We will present the draft model and highlight exemplar items. Conclusion The conceptual model and corresponding tools emerging from this integrated work with groups of young people is expected to contribute to a meaningful and dramatic shift in the ways that we understand sexual wellbeing, respectful of the many complexities that adolescents’ lives represent.

Purpose: In the past 2 years, nearly all 50 states have debated bills seeking to ban minors' access to gender-affirming medical interventions, with many being passed into law. This study documents gender-diverse youths' (GDY) and their caregivers' experiences as they grapple with how such laws impact their families. Methods: Sixteen GDY and 16 caregivers participating in a longitudinal study of the impact of gender-affirming care on GDYs' well-being were interviewed about how the legal and social discourse was impacting them and their families. When interviewed, some participants had completed only the initial intake, others had completed the intake and an initial medical consultation, and a few had recently started gender-affirming hormones. Thematic analysis was used to identify common threads in the youths' and caregivers' experiences. Results: Four main themes were identified: Direct effects of losing access to gender-affirming medical interventions, reflecting how losing access to care would impact well-being; growing hostility toward the gender-diverse community, noting increasing social negativity; personal and social upheaval, reflecting the many aspects of families' lives affected; and galvanization into social action, documenting drives to effect social change. Conclusion: Laws banning gender-affirming medical interventions impact GDY and their families beyond limiting access to medical care. They increase the social stressors, cause social network disruptions, increase hostility toward the gender-diverse community, and lead some GDY and caregivers to engage more politically to protect their community. Gender-affirming health care providers need to recognize how the social and political environment impact GDY and their families to provide high-quality, person-centered care.

Introduction Teen pregnancy (TP) rates are 1.5 times higher among Latina youth than the United States national average and one-third times higher in rural counties. The Socio-Ecological framework recognizes the myriad of issues that impact TP, including four bidirectional levels of influence on teenagers’ behaviors: macro, community, institutional, and interpersonal levels. We aim to fill critical knowledge gaps regarding the influence of key community stakeholders living in rural, Latino-majority communities shaping Latino/a, immigrant adolescents’ TP-related environments. Methods A purposive sample of 48 key stakeholders was drawn from three rural counties (Finney, Ford, and Seward) in southwestern Kansas from 2016 to 2017; participants completed a brief demographic survey and a semi-structured qualitative interview. Qualitative data analysis followed grounded theory within a Socio-Ecological framework, and we used descriptive statistics to analyze survey data. Results Respondents (N = 48) included 5 public health department staff, 8 community health workers, 8 healthcare workers, 9 community members, and 18 high school/college administrators. The mean age was 43 years (SD = 15.5) and 50% self-identified as Latino/a. Recommendations included developing TP prevention education programs for parents, utilizing ongoing events and familiar venues, and keeping content consistent with local culture and norms. Conclusions Key stakeholders’ perceptions regarding TP are often unaccounted for but play a role in shaping youth’s decision-making environments. Policy Implications This information could inform the development of culturally specific TP prevention interventions, especially considering the controversial politics centered on immigration to the U.S. and its negative impact on the overall health of Immigrant Latinos living in the U.S.