Center For Innovative Public Health Research

HARNESSING THE POWER OF TEXT MESSAGING TO REDUCE HIV INCIDENCE IN ADOLESCENT MALES ACROSS THE UNITED STATES - SEXUAL MINORITY MALE YOUTH FACE DISPARATE RISK FOR HIV ACQUISITION. DISPARITIES ARE EVEN STARKER FOR AFRICAN AMERICAN/BLACK AND HISPANIC SEXUAL MINORITY MALE YOUTH, WHO ACCOUNT FOR 51% AND 25% OF NEW HIV INFECTIONS, RESPECTIVELY. YOUTH LIVING IN SOUTHERN STATES AND IN RURAL SETTINGS ALSO FACE ELEVATED RISK FOR HIV ACQUISITION. AS SUCH, ACCESS TO HIV TESTING AND COUNSELING REMAINS A CRITICAL COMPONENT OF PREVENTION, AND EFFECTIVELY EXTENDING THESE SERVICES TO SEXUAL MINORITY MALE YOUTH IS A PRIORITY. THE WIDE ADOPTION OF TEXT MESSAGING PROVIDES NOVEL OPPORTUNITIES TO GO WHERE YOUTH “ARE” ACROSS SOCIO- DEMOGRAPHICALLY DIFFERENT GROUPS, AND OVERCOMES STRUCTURAL CHALLENGES OF TRADITIONAL INTERVENTIONS. MOREOVER, BEING ABLE TO ACCESS SENSITIVE CONTENT WHEN AND WHERE ONE CHOOSES FACILITATES SAFE SPACES FOR YOUTH TO ENGAGE WITH THE CONTENT, WHICH IS IMPORTANT FOR THOSE WHO ARE NOT ‘OUT’. IMPORTANTLY TOO, REVIEWS SUGGEST THAT PROGRAMS DELIVERED VIA TEXT MESSAGING CAN AFFECT COMPLEX BEHAVIOR CHANGE, INCLUDING HIV TESTING AMONG SEXUAL MINORITY ADOLESCENT BOYS. THUS, WE HAVE THE OPPORTUNITY TO UTILIZE THE POWER AND REACH THAT TEXT MESSAGING AFFORDS TO DELIVER AN HIV PREVENTION PROGRAM ACROSS THE COUNTRY TO A DIVERSE POPULATION OF YOUTH. TO THIS END, WE PROPOSE TO TEST THE IMPACT OF #GROWINGUPGUY (#GUY) ON NEW HIV INFECTIONS AMONG 13-20 YEAR-OLD SEXUAL MINORITY MALE YOUTH ACROSS THE UNITED STATES. #GUY WILL BE AN ADAPTATION OF THE RESEARCH TEAM’S PREVIOUS TEXT MESSAGING-BASED HIV PREVENTION/HEALTHY SEXUALITY PROGRAMS DEVELOPED AT THE NATIONAL LEVEL FOR SEXUAL MINORITY YOUTH. GIVEN THE EPIDEMIOLOGY OF HIV INFECTIONS IN THE UNITED STATES, WE PLAN TO TARGET YOUTH 13-20 YEARS OF AGE. BECAUSE OF THE LACK OF ACCESSIBLE PROGRAMS FOR YOUNGER YOUTH, OUR RECRUITMENT EFFORT WILL PLACE AN EMPHASIS ON THOSE 18 YEARS OF AGE AND YOUNGER. SAMPLE DIVERSITY WILL BE ENSURED USING RECRUITMENT TARGETS AND A COMPLEX ENROLLMENT STRATEGY THAT WE HAVE DEVELOPED AND REFINED OVER OUR INTERVENTION ENDEAVORS SUCH THAT HALF WILL SELF-IDENTIFY AS BLACK/AFRICAN AMERICAN, LATINO, AND/OR OF MIXED RACE; AND AT LEAST 20% WILL BE LIVING IN A RURAL AREA OR SOUTHERN STATE. SPECIFICALLY, WE AIM TO: SPECIFIC AIM 1: FINALIZE THE GROWINGUPGUY (#GUY) INTERVENTION AND PROTOCOL FOR SEXUALLY ACTIVE, HIV NEGATIVE, CISGENDER, SEXUAL MINORITY BOYS AND MEN UP TO 20 YEARS OF AGE ACROSS THE UNITED STATES. SPECIFIC AIM 1A. ADAPT PREVIOUS INTERVENTION CONTENT TO CREATE GROWINGUPGUY (#GUY), A SALIENT, TECHNOLOGICALLY DELIVERED HIV PREVENTION PROGRAM. SPECIFIC AIM 1B: FINALIZE THE INTERVENTION PROTOCOL, INCLUDING CONFIRMATION OF HIV TEST RESULTS. SPECIFIC AIM 2: TEST THE #GUY INTERVENTION FOR IMPACT ON HIV INCIDENCE (N=5,000). OUR MAIN OUTCOME MEASURES WILL BE: 1) ORAQUICK-CONFIRMED HIV INCIDENCE; AND SELF-REPORTED 2) PREP AND PEP USE, 3) HIV STATUS, AND 4) NUMBER OF STIS. SECONDARY OUTCOMES INCLUDE: 1) INFORMATION ABOUT AND 2) MOTIVATION FOR UPTAKE OF PREP; AND 3) THE IMPACT OF THE INTERVENTION ON MENTAL HEALTH INDICATORS.

ANNOUNCEMENT OF AVAILABILITY OF FUNDS FOR RIGOROUS EVALUATION OF NEW OR INNOVATIVE APPROACHES TO PREVENT TEEN PREGNANCY (TIER 2B)

COURSE AND PREDICTION OF SEXUAL PERPETRATION IN ADOLESCENCE THROUGH YOUNG ADULTHOOD

USING AI TO UNPACK THE BI-DIRECTIONAL ASSOCIATION BETWEEN ADOLESCENT SOCIAL MEDIA EXPOSURE AND MENTAL HEALTH AND WELL BEING - ABSTRACT WITH NOTABLE INCREASES IN RATES OF ADOLESCENT DEPRESSION OVER THE LAST DECADE, MANY RESEARCHERS ARE LOOKING TO UNDERSTAND THE CAUSES, WITH SOCIAL MEDIA BEING A MAIN FOCUS. ALTHOUGH THE RELATION IS FAR FROM CONCLUSIVE, A SUFFICIENT NUMBER OF STUDIES HAVE EMERGED TO SUGGEST HARMFUL MENTAL HEALTH IMPACTS THAT FURTHER INQUIRY OF ADOLESCENT SOCIAL MEDIA USE SEEMS WARRANTED. CURRENT FINDINGS ARE CONFLICTING, PERHAPS IN PART BECAUSE THE RELATION IS BI-DIRECTIONAL. PUBLISHED RESEARCH DOES NOT WELL SPEAK TO THIS HYPOTHESIS. IN RESPONSE TO RFA-MH-25-205, “BIDIRECTIONAL INFLUENCES BETWEEN ADOLESCENT SOCIAL MEDIA USE AND MENTAL HEALTH,” WE PROPOSE TO RECRUIT AND SURVEY NATIONALLY 2,000 13-16 YEAR-OLDS AND FOLLOW THEM PROSPECTIVELY AS THEY AGE INTO MIDDLE AND LATER ADOLESCENCE, WHEN THEY ARE 16-19 YEARS OF AGE. YOUTH WILL COMPLETE EIGHT COMPREHENSIVE ONLINE SURVEYS: ONE AT BASELINE AND ANOTHER EVERY 3-MONTHS THEREAFTER FOR THE FIRST YEAR, AND EVERY 6 MONTHS FOR THE SUBSEQUENT 1.5 YEARS. BRIEF SNAPSHOTS OF SOCIAL MEDIA AND MOOD WILL BE COLLECTED QUARTERLY DURING 4-DAY ECOLOGICAL MOMENTARY ASSESSMENTS (EMAS). OBJECTIVE MEASURES OF ADOLESCENT INSTAGRAM USE, THE 2ND MOST COMMONLY USED SOCIAL MEDIA APP AMONG YOUTH PEOPLE, WILL BE CONTINUOUSLY COLLECTED VIA INSTAGRAM’S API AND CODED USING AI. OUR RESEARCH TEAM WILL ACHIEVE THE FOLLOWING: SPECIFIC AIM 1: CONDUCT FOCUS GROUPS TO HEAR FROM YOUTH THE EXPERIENCES AND FEATURES OF BOTH THEIR ONLINE AND IN-PERSON WORLDS THAT THEY THINK ARE IMPACTING THEIR MENTAL HEALTH. TO ENSURE THAT ONLINE SURVEY INSTRUMENT QUERIES ALL RELEVANT EXPOSURES AND OUTCOMES, WE WILL CONDUCT 6 NATIONAL, ONLINE FOCUS GROUPS WITH 120 YOUTH. THEIR FEEDBACK WILL BE INTEGRATED INTO THE FINAL ONLINE SURVEY INSTRUMENT. SPECIFIC AIM 2. RECRUIT AND SURVEY 2,000 13-16 YEAR-OLDS LIVING IN THE UNITED STATES. OUR MAIN EXPOSURE OF INTEREST WILL BE OBJECTIVE MEASURES OF INSTAGRAM USE. SECONDARY EXPOSURE MEASURES WILL BE SOCIAL MEDIA USE AS MEASURED IN THE EMAS AND ONLINE SURVEYS. OUR MAIN OUTCOMES OF INTEREST WILL BE SCALE-BASED MEASURES OF: 1) DEPRESSION, 2) SUICIDAL IDEATION AND 3) SUICIDAL BEHAVIOR ASSESSED IN THE ONLINE SURVEYS. SECONDARY OUTCOME MEASURES WILL INCLUDE SINGLE-ITEM EMA-COLLECTED: 1) HAPPINESS AND 2) LIFE SATISFACTION. SPECIFIC AIM 3. USE LONGITUDINAL DATA TO INVESTIGATE THE BIDIRECTIONAL IMPACT THAT ONE’S MENTAL HEALTH MAY HAVE ON YOUTH SOCIAL MEDIA USE, AND HOW THEIR SOCIAL MEDIA USE MAY IMPACT YOUTH MENTAL HEALTH. GUIDED BY THE SOCIO-ECOLOGICAL MODEL, WE WILL EXAMINE HOW POTENTIALLY INFLUENTIAL FACTORS ACROSS THE SOCIAL ECOLOGY, PARTICULARLY THOSE THAT ARE IN-PERSON, CONTEXTUALIZE OBSERVED RELATIONS BETWEEN SOCIAL MEDIA USE AND MENTAL ILLNESS AND HEALTH OVER TIME. STUDY FINDINGS WILL INFORM PREVENTION EFFORTS BY GUIDING CONTENT THAT HELPS YOUTH ACHIEVE HEALTHY SOCIAL MEDIA HABITS, AS WELL AS MENTAL HEALTH PROMOTION EFFORTS THAT LIKELY NEED TO TAKE A HOLISTIC VIEW OF YOUTH AND PROVIDE PREVENTION EFFORTS AIMED AT A YOUNG PERSON’S WHOLE EXPERIENCE, NOT JUST THEIR ONLINE – OR OFFLINE – WORLD.

ADOLESCENT HEALTH BEHAVIORS IN THE TIME OF COVID-19 - ABSTRACT THE COVID-19 PANDEMIC AND RELATED PUBLIC HEALTH POLICIES (E.G., PHYSICAL DISTANCING, SCHOOL CLOSURES, VACCINE DISTRIBUTION) ARE LIKELY IMPACTING THE SHORT- AND LONG-TERM SEXUAL HEALTH BEHAVIORS OF ADOLESCENTS IN THE UNITED STATES (US). ALTHOUGH ESSENTIAL TO MITIGATE THE EFFECTS OF COVID-19 ON POPULATION HEALTH, THESE NECESSARY PUBLIC HEALTH MEASURES MAY BE SUBSTANTIALLY DISRUPTING THE PROVISION OF AND ACCESS TO SEXUAL HEALTH SERVICES (I.E., CONTRACEPTION, HIV/STI TESTING, PRE-EXPOSURE PROPHYLAXIS [PREP]). FURTHER, EMERGING EVIDENCE UNDERSCORES THE DRASTIC IMPACT OF PHYSICAL DISTANCING MEASURES ON SEXUAL BEHAVIORS, AS WELL AS MENTAL HEALTH AND SUBSTANCE USE. THE NASCENT RESEARCH IN THIS AREA HAS BEEN AMONG ADULTS. IT IS LIKELY THAT THESE EFFECTS MAY BE EVEN MORE PRONOUNCED AMONG ADOLESCENTS GIVEN THEIR DEVELOPMENTAL STAGE. YOUTH 13–17 YEARS OF AGE IN THE US ARE SUBSTANTIALLY BURDENED BY SEXUALLY TRANSMITTED INFECTIONS (STIS) AND UNINTENDED PREGNANCIES. PRELIMINARY DATA SUGGEST THAT THE COVID-19 PANDEMIC AND RELATED POLICIES MAY BE HAVING BOTH DELETERIOUS EFFECTS, INCLUDING DECREASED ACCESS TO STI TESTING, WHILE ALSO HAVING POTENTIALLY POSITIVE IMPACTS, SUCH AS REDUCED OPPORTUNITIES FOR CONDOMLESS SEX ACTS ON ADOLESCENT SEXUAL HEALTH. THE EFFECTS OF COVID-19 AND RELATED POLICIES ON ADOLESCENT SEXUAL HEALTH BEHAVIORS HAVE YET TO BE SYSTEMATICALLY INVESTIGATED, HOWEVER. FURTHER, COVID-19 MAY BE AMPLIFYING EXISTING SEXUAL HEALTH DISPARITIES EXPERIENCED BY SEXUAL AND GENDER MINORITY (SGM) AND RACIAL/ETHNIC MINORITY YOUTH. GIVEN THAT COVID-19 IS DISPROPORTIONATELY IMPACTING MARGINALIZED COMMUNITIES, IT IS PARTICULARLY CRITICAL TO UNDERSTAND HOW THE PANDEMIC IS INFLUENCING THE SEXUAL HEALTH OF YOUTH FACING HEALTH DISPARITIES. TO INVESTIGATE HOW THE COVID-19 PANDEMIC AND RELATED PUBLIC HEALTH POLICIES ARE IMPACTING THE SEXUAL HEALTH BEHAVIORS OF ADOLESCENTS BOTH IN THE SHORT- AND LONG-TERM, WE PROPOSE TO RECRUIT VIA SOCIAL MEDIA AND SURVEY ONLINE A LONGITUDINAL COHORT OF 2000 13–17-YEAR-OLDS FROM ACROSS THE US. SGM AND RACIAL/ETHNIC MINORITY YOUTH WILL BE OVER-RECRUITED. WE WILL SURVEY YOUTH 12 TIMES OVER THE COURSE OF 3.5 YEARS TO: (1) IDENTIFY THE IMMEDIATE IMPACT OF COVID-19 ON THEIR SEXUAL HEALTH BEHAVIORS (HIV/STI ACQUISITION; UNINTENDED PREGNANCY; NUMBER OF PENILE-VAGINAL AND PENILE-ANAL SEX ACTS, RESPECTIVELY; NUMBER OF CONDOM- AND CONTRACEPTIVE-PROTECTED SEX ACTS; HIV/STI TESTING; AND PREP UPTAKE); (2) IDENTIFY LONGITUDINAL TRENDS IN SEXUAL HEALTH BEHAVIORS AS THE COVID-19 PANDEMIC AND RELATED PUBLIC HEALTH POLICIES CHANGE; AND (3) EXAMINE HOW TRENDS VARY BY IMPORTANT SUBGROUPS OF YOUTH (I.E., BY SEX ASSIGNED AT BIRTH, GENDER, SEXUAL IDENTITY, AND RACIAL/ETHNIC IDENTITY). THE COVID-19 PANDEMIC HAS DRASTICALLY CHANGED THE LIVES OF ADOLESCENTS ACROSS THE US IN A VERY SHORT AMOUNT OF TIME. UNDERSTANDING HOW THIS CHANGE RELATES TO THEIR SEXUAL HEALTH BEHAVIORS WILL BE CRITICAL TO CONTINUING TO REDUCE HEALTH DISPARITIES AMONG ADOLESCENTS.

HARNESSING THE POWER OF TECHNOLOGY TO DEVELOP A POPULATION-BASED HIV PREVENTION PROGRAM FOR TRANS GIRLS - ESTIMATES SUGGEST THAT ONE IN FIVE TRANSGENDER GIRLS MAY BE HIV POSITIVE IN THE FACE OF THIS HEALTH DISPARITY, THE NEAR-COMPLETE ABSENCE OF GENDER-INCLUSIVE HEALTHY SEXUALITY PROGRAMS IS DEAFENING. TO ADDRESS THE LACK OF GENDER INCLUSIVE HIV PREVENTION PROGRAMMING, WE PROPOSE TO DEVELOP AND TEST #TRANSCENDENTHEALTH. CONTENT WILL FOCUS ON PROVIDING GIRLS WITH A PANOPLY OF RISK REDUCTION STRATEGIES, INCLUDING FREQUENT HIV/STI TESTING AND INITIATING PREP, SO THAT THEY CAN CHOOSE OPTIONS THAT FIT BEST FOR THEM. MESSAGING WILL BE GENDER AFFIRMING WHILE INCREASING ONE’S HIV PREVENTIVE INFORMATION, MOTIVATION, AND BEHAVIORAL SKILLS. CONTENT WILL FOSTER PRIDE IN GIRLS’ GENDER IDENTITY AND REDUCE INTERNALIZED TRANSPHOBIA THEY MAY BE EXPERIENCING. WE WILL HARNESS THE REACH AND WIDE ADOPTION OF TEXT MESSAGING AMONG YOUTH TO DELIVER INTERVENTION CONTENT. THIS NATIONAL REACH WILL INCREASE ITS GENERALIZABILITY AND TRANSLATIONAL PROPERTIES. IN RESPONSE TO RFA-OD-19-029, THIS PROPOSAL ADDRESSES NIMH’S HIGH PRIORITY AREA OF RESEARCH: INTERVENTION RESEARCH TO IMPROVE HIV PREVENTION AND TREATMENT OUTCOMES FOR TRANSGENDER INDIVIDUALS THAT FOCUSES ON THE INFLUENCES OF SEX AND GENDER (STRATEGIC GOAL 1.3). SPECIFICALLY, WE AIM TO: SPECIFIC AIM 1: EXPLORE HOW THE INTERSECTIONALITY OF SEX AND GENDER INFORM THE SEXUAL DECISION MAKING OF TRANSGIRLS 14-18 YEARS OF AGE (N=80). LITTLE IS KNOWN ABOUT HOW TRANSGIRLS DECIDE WHEN AND WITH WHOM TO HAVE SEX OR NOT, AS WELL AS HOW THEIR UNDERSTANDING OF THEIR GENDER WITHIN THE CONTEXT OF THEIR SEX INFLUENCES THEIR SEXUAL DECISION-MAKING. TO EXPLORE THESE ISSUES, WE WILL CONDUCT ONLINE FOCUS GROUPS. SPECIFIC AIM 2: ITERATIVELY DEVELOP #TRANSCENDENTHEALTH, A GENDER INCLUSIVE HIV PREVENTION PROGRAM FOR TRANSGIRLS, WITH ONGOING INPUT FROM TRANSGIRLS (N=35). WE WILL INTEGRATE FINDINGS FROM THE FOCUS GROUPS INTO CONTENT TAILORED TO THE LIVED EXPERIENCES OF TRANSGIRLS 14-18 YEARS OF AGE. TO ENSURE THAT THE MESSAGING IS AFFIRMING AND ACCEPTABLE, WE THEN WILL CONDUCT CONTENT ADVISORY TEAMS (CATS), AND THEN T A BETA TEST TO CONFIRM THE PROTOCOL. SPECIFIC AIM 3: TEST THE #TRANSCENDENTHEALTH HIV PREVENTION PROGRAM WITH TRANSGIRLS 14-18 YEARS OF AGE ACROSS THE UNITED STATES (N=200). OUR MAIN OUTCOME MEASURES WILL BE FEASIBILITY AND ACCEPTABILITY. BEHAVIORAL OUTCOMES WILL BE EXPLORATORY AND INCLUDE THOSE ON THE HIV PREVENTION CONTINUUM41: 1) ACCEPTABILITY OF, 2) MOTIVATION FOR, AND 3) UPTAKE OF PREP, IF CLINICALLY INDICATED; AND 3) HIV/STI TESTING AND RECEIPT OF RESULTS AT 3-MONTH FOLLOW-UP. PHOTO-VERIFIED TESTING ALSO WILL BE EXPLORED. SPECIFIC AIM 4: UNDERSTAND HOW THE INTERSECTIONALITY OF SEX AND GENDER IMPACT THE INTERVENTION EXPERIENCE. WE WILL EXAMINE WHETHER TRANSGIRLS WHO ARE UNDERGOING GENDER AFFIRMING HORMONE THERAPY, HAVE INTERNALIZED TRANSPHOBIA, AND DIFFERENT GENDER IDENTITIES EXPERIENCE THE INTERVENTION DIFFERENTLY THAN OTHER GENDER MINORITY TEENS.

IN THIS TOGETHER: TESTING A POPULATION-BASED TEXT MESSAGING-BASED HIV PREVENTION PROGRAM FOR YOUNG ADULTS ACROSS UGANDA - TO HARNESS THE POTENTIAL OF TEXT MESSAGING TO DELIVER RESEARCH-DRIVEN HIV PREVENTIVE INFORMATION DURING A CRITICAL AGE PERIOD, WE DEVELOPED AND PILOT TESTED IN THIS TOGETHER (ITG; R34MH109296), AN HIV PREVENTION PROGRAM DEVELOPED SPECIFICALLY FOR, AND WITH ONGOING FEEDBACK FROM, 18-22 YEAR-OLDS ACROSS UGANDA. ITG IS ONE OF THE FIRST COMPREHENSIVE, TEXT MESSAGING-BASED HIV PREVENTION PROGRAMS DEVELOPED AND TESTED NATIONALLY IN ANY SUB-SAHARAN AFRICAN COUNTRY. FINDINGS FROM THE R34 SUGGEST THAT, DESPITE THE SMALL SAMPLE SIZE (N=150) AND THE INCLUSION OF YOUTH ACROSS THE HIV BEHAVIORAL RISK SPECTRUM, ITG IS ASSOCIATED WITH HIGHER RATES OF CONDOM-PROTECTED SEX (AIRR = 1.68, P<.001) AND ODDS OF HIV TESTING (AOR = 2.41, P = 0.03). HERE, WE PROPOSE TO BUILD UPON THIS PROMISING R34 PILOT BY CONDUCTING A WELL-POWERED EFFICACY TRIAL. REACH WILL BE EXPANDED BY TRANSLATING THE INTERVENTION INTO 3 ADDITIONAL LANGUAGES. SPECIFICALLY, WE AIM TO: PRIMARY AIM: MEASURE THE 12-MONTH EFFICACY OF ITG ON HIV PREVENTIVE BEHAVIORS FOR UGANDAN YOUTH 18-22 YEARS OF AGE IN A NATIONAL RCT (N=750). WE WILL CONDUCT A 17-MONTH RCT, THEREBY EXTENDING OUR R34 WORK BY INCREASING OUR OBSERVATION PERIOD BY 12 MONTHS AND BY HAVING A FULLY POWERED SAMPLE SIZE. PRIMARY AIM 1 A: TEST WHETHER ITG IS MORE EFFECTIVE IN HIV PREVENTION WHEN COMPARED TO CONTROL CONDITIONS. OUR MAIN OUTCOME MEASURES WILL BE: (I) THE RATE OF CONDOM-PROTECTED SEX ACTS AND (II) HIV TESTING. SECONDARY OUTCOMES WILL BE (III) STI TESTING AND (IV) THE ODDS OF PREP UPTAKE AMONG THOSE ELIGIBLE. PRIMARY AIM 1 B: USING A FRACTIONAL FACTORIAL-BASED MOST DESIGN, WE WILL IDENTIFY THE IMPACT THAT INTERVENTION COMPONENTS HAVE ON BEHAVIOR CHANGE. PARTICIPANTS WHO ARE IN THE INTERVENTION WILL BE FURTHER RANDOMIZED TO ONE OF FOUR ARMS PREDICATED ON HAVING OR NOT HAVING THE THREE INTERACTIVE FEATURES: 1) LEVEL UP QUIZ QUESTIONS; 2) MILESTONE-DRIVEN BADGES (E.G., CARRYING CONDOMS); AND 3) ACCESS TO ON-DEMAND ADVICE. SECONDARY AIM: ASSESS RCT OUTCOMES BY FACTORS ASSOCIATED WITH HIV ACQUISITION: SEX, URBAN/RURAL SETTING, AND EDUCATION. PEOPLE WHO ARE WOMEN, LIVE IN URBAN AREAS, AND HAVE LOWER EDUCATIONAL ATTAINMENT FACE HIGHER HIV RISK. WE WILL FURTHER EXTEND OUR R34 BY EXAMINING HERE INTERVENTION IMPACT FOR IMPORTANT SUBGROUPS. FINDINGS WILL INFORM POTENTIAL FUTURE TARGETING AND ALSO ADAPTATIONS OF ITG. EXPLORATORY AIM: MEASURE THE FEASIBILITY AND ACCEPTABILITY OF PHOTO-VERIFICATION OF HIV TESTING. THE NATIONAL REACH OF ITG RESULTS IN A STRONGER PUBLIC HEALTH POTENTIAL THAN A LOCALIZED INTERVENTION BECAUSE YOUTH FROM VARIED BACKGROUNDS - PARTICULARLY THOSE OUTSIDE OF KAMPALA AND WITHOUT ACCESS TO LOCAL HEALTHCARE RESOURCES - CAN BE ENGAGED AND AFFECTED. IT ALSO MAKES VERIFICATION OF HIV TESTING DIFFICULT BECAUSE THE GATHERING OF CLINIC DATA IS COMPLEX EVEN FOR LOCAL, LET ALONE, NATIONAL COHORTS. AS SUCH, WE WILL PILOT A PHOTO VERIFICATION PROCEDURE THAT DR. BOGART INNOVATED WITH A DIFFERENT POPULATION IN A DIFFERENT REGION. THE MINISTRY OF HEALTH WILL GUIDE US ON SUSTAINABILITY SHOULD THE FINDINGS OF THIS R01 WARRANT.

CYBERSENGA: HARNESSING THE POWER OF THE INTERNET TO PREVENT HIV IN UGANDAN YOUTH

HARNESSING THE POWER OF TEXT MESSAGING TO INVIGORATE AMSM HIV PREVENTIVE BEHAVIOR

#TRANSCENDENTHEALTH - ADAPTING AN LGB+ INCLUSIVE TEEN PREGNANCY PREVENTION PROGRAM FOR TRANSGENDER BOYS - YOUTH WHO ARE ASSIGNED FEMALE AT BIRTH (AFAB) AND IDENTIFY AS TRANSGENDER (E.G., AS NON-BINARY OR AS TRANS BOYS), NOT AS GIRLS, ARE AT RISK FOR NEGATIVE SEXUAL HEALTH OUTCOMES YET ARE EFFECTIVELY EXCLUDED FROM SEXUAL HEALTH PROGRAMS BECAUSE GENDER-DIVERSE YOUTH DO NOT EXPERIENCE THE CISGENDER, HETERONORMATIVE TEEN SEXUAL EDUCATION MESSAGING AVAILABLE TO THEM AS SALIENT OR APPLICABLE. THIS LACK OF PROGRAMMING IS LIKELY CONTRIBUTING TO OBSTACLES TO SEXUAL HEALTH: DATA SUGGEST THAT AFAB TRANS-IDENTIFIED YOUTH MAY BE LESS LIKELY TO USE CONDOMS WHEN HAVING SEX WITH PEOPLE WHO HAVE PENISES AND ARE AT LEAST AS LIKELY AS CISGENDER GIRLS TO BE PREGNANT. THIS HEALTH INEQUITY MUST BE ADDRESSED. ACCESS TO INCLUSIVE SEXUAL EDUCATION, CONDOMS, AND SEXUAL HEALTH SUPPORT CAN VARY WIDELY ACROSS REGIONS OF THE US, AND WITHIN STATES FOR THOSE LIVING IN RURAL VERSUS URBAN SETTINGS. THIS IS PARTICULARLY TRUE NOW THAT STATES HAVE MORE INFLUENCE ON ADOLESCENTS’ ACCESS TO SEXUAL HEALTH SERVICES AND GENDER-AFFIRMING CARE. OUR COMPREHENSIVE SEXUAL HEALTH PROGRAM WILL BE DEVELOPED NATIONALLY FOR MAXIMAL IMPACT. THE FOUNDATION FOR THIS R01 PROPOSAL IS OUR WORK WITH GIRL2GIRL, A TEXT MESSAGING-BASED SEXUAL HEALTH PROGRAM DESIGNED FOR CISGENDER SEXUAL MINORITY GIRLS 14-18 YEARS OF AGE. IN AN RCT OF 948 LGB+ GIRLS, GIRL2GIRL WAS ASSOCIATED WITH HIGHER RATES OF CONDOM-PROTECTED PENILE-VAGINAL SEX (F2=.11) AND USE OF BIRTH CONTROL OTHER THAN CONDOMS (F2=.13) AT 12 MONTHS POST-INTERVENTION. WE PROPOSE TO ADAPT GIRL2GIRL TO ADDRESS SOCIAL AND STRUCTURAL INFLUENCES OF SEXUAL BEHAVIOR OF AFAB TRANS-IDENTIFIED YOUTH, INCLUDING SIGNIFICANT SOCIAL STRESSORS, DISCRIMINATION, DYSPHORIA AND REJECTION. IN SO DOING, THIS PROPOSAL ADDRESSES THE NATIONAL INSTITUTE OF NURSING RESEARCH’S (NINR) RESEARCH LENS ON HEALTH EQUITY. IT ALSO SPEAKS TO NINR’S RESEARCH LENS ON PREVENTION AND HEALTH PROMOTION ACROSS THE PREVENTION CONTINUUM BY INCLUDING BOTH SEXUALLY EXPERIENCED AND INEXPERIENCED YOUTH. SPECIFICALLY, WE AIM TO: SPECIFIC AIM 1: WITH ONGOING FEEDBACK FROM TRANS-IDENTIFIED YOUTH ASSIGNED FEMALE AT BIRTH, ADAPT GIRL2GIRL FOR GENDER INCLUSIVITY TO CREATE #TRANSCENDENTHEALTH. FIRST, WE WILL CONDUCT FOCUS GROUPS (N=80) TO IDENTIFY AND GIVE VOICE TO THE CONTEXTS THAT AFFECT SEXUAL DECISION MAKING OF AFAB TRANS-IDENTIFIED YOUTH. AFTER ADAPTING THE CONTENT, WE WILL CONDUCT CONTENT ADVISORY TEAMS (CATS; N=50) TO ENSURE THAT PROGRAM CONTENT RESONATES WITH THESE YOUTH. FINALLY, WE WILL CONDUCT A BETA TEST (N=22) TO CONFIRM THE PROTOCOL. SPECIFIC AIM 2: TEST THE RESULTING ADAPTATION IN A NATIONAL RCT OF 700 TRANS-IDENTIFIED AFAB YOUTH 14-18 YEARS OF AGE. OUR MAIN OUTCOME MEASURES WILL BE: 1) RATES OF CONDOM-PROTECTED SEX, 2) USE OF OTHER TYPES OF BIRTH CONTROL METHODS (E.G., THE SHOT, IUDS) OTHER THAN CONDOMS, 3) HIV/STI TESTING, AND 4) PREP UPTAKE FOR THOSE FOR WHOM IT IS INDICATED. SECONDARY MEASURES ALSO WILL INCLUDE PREGNANCY, AND INTENTIONS TO: 1) USE CONDOMS, 2) UPTAKE OTHER BIRTH CONTROL METHODS, 3) TEST FOR STIS AND 4) UPTAKE PREP.

MAPPING ETIOLOGICAL PATHWAYS TO SV PERPETRATION FROM CHILDHOOD TO YOUNG ADULTHOOD

A REPRODUCTIVE HEALTH PROGRAM FOR A SELECT POPULATION

UNDERSTANDING HOW ALCOHOL USE AFFECTS ADOLESCENT COVID-19 ACQUISITION AND DISEASE COURSE OVERTIME - ONE IN SIX 14-17 YEAR-OLDS (16.3%) HAVE TESTED POSITIVE FOR COVID-19. UNDERSTANDING THE FACTORS THAT CONFER INCREASED RISK IS IMPERATIVE GIVEN ADOLESCENTS’ VULNERABLE DEVELOPMENTAL STAGE. ONE PARTICULARLY SALIENT RISK FACTOR MAY BE ALCOHOL USE, BOTH BECAUSE INTENSE ALCOHOL USE NEGATIVELY IMPACTS IMMUNE SYSTEM FUNCTIONING AND SLEEP PATTERNS, AND ALSO BECAUSE CONSUMING ALCOHOL WITH OTHERS COULD LEAD TO LOWERED INHIBITIONS THAT RESULT IN REDUCED SOCIAL DISTANCING. COVID-19 ALSO MAY BE IMPACTING THE WAY IN WHICH ADOLESCENTS CONSUME ALCOHOL, POTENTIALLY WITH LIFE-LONG CONSEQUENCES. UNDERSTANDING HOW PANDEMIC EXPERIENCES HAVE AFFECTED THE FREQUENCY AND INTENSITY OF ALCOHOL USE IS NECESSARY FOR ENSURING SUFFICIENT TREATMENT SUPPORTS FOR YOUTH. IT ALSO IS CRUCIAL TO KNOW HOW ALCOHOL MAY AFFECT THE COVID-19 DISEASE COURSE, INCLUDING THE SEVERITY AND LONG-TERM IMPACT ON SOMATIC AND MENTAL HEALTH. THE PANDEMIC ALSO HAS REIFIED LONG-STANDING HEALTH INEQUITIES. INDEED, DATA OVERWHELMING SUGGEST THAT BLACK/AFRICAN AMERICAN AND HISPANIC PEOPLE ARE SIGNIFICANTLY MORE LIKELY TO ACQUIRE COVID-19, AND TO HAVE A WORSE DISEASE COURSE. THE SAME IS TRUE FOR PEOPLE WHO IDENTIFY AS A SEXUAL AND GENDER MINORITY (SGM). BEFORE THE PANDEMIC, HIGH SCHOOL-AGED SGM YOUTH REPORTED HIGHER RATES OF ALCOHOL USE THAN NON-SGM YOUTH, WHEREAS RATES WERE SIMILAR FOR HISPANIC AND WHITE YOUTH AND SIGNIFICANTLY LOWER FOR BLACK/AFRICAN AMERICAN YOUTH. ENSURING THAT WE UNDERSTAND HOW PANDEMIC EXPERIENCES AND ALCOHOL TOGETHER MAY BE CONFERRING RISK SIMILARLY AND DIFFERENTLY FOR THESE MINORITY ADOLESCENT POPULATIONS IS FUNDAMENTAL TO ADDRESSING DISPARITIES. IN RESPONSE TO RFA-AA-21-002, WE PROPOSE TO RECRUIT AND SURVEY 2,500 14-18 YEAR-OLDS, 500 OF WHOM WILL HAVE TESTED POSITIVE FOR COVID-19 IN THE PAST 3 MONTHS AND 2,000 OF WHOM WILL HAVE NEVER TESTED POSITIVE FOR COVID-19. USING PROCEDURES SUCCESSFULLY IMPLEMENTED BY THE RESEARCH TEAM PREVIOUSLY, ADOLESCENTS WILL BE RECRUITED ON SOCIAL MEDIA AND SURVEYED ONLINE. THIS WILL AFFORD A NATIONAL SCOPE WHILE EMPOWERING YOUTH TO ENGAGE IN THIS SENSITIVE SURVEY TOPIC WHERE AND WHEN IT IS SAFE FOR THEM. YOUTH WHO HAVE TESTED POSITIVE FOR COVID-19 AT BASELINE WILL BE ASKED TO RETROSPECTIVELY REPORT THEIR DISEASE SEVERITY, PROGRESSION, AND OUTCOMES, AS WELL AS THEIR CURRENT COVID-19-RELATED SYMPTOMS. BOTH YOUTH WHO HAVE BEEN POSITIVE AND THOSE WHO ARE NEGATIVE FOR COVID-19 WILL PROVIDE INFORMATION ABOUT THEIR PAST AND CURRENT ALCOHOL USE, AS WELL AS PAST AND CURRENT COVID-PROTECTIVE AND -RISK BEHAVIORS. ALL YOUTH THEN WILL BE PROSPECTIVELY FOLLOWED FOR 24 MONTHS. THEY WILL COMPLETE COMPREHENSIVE ONLINE SURVEYS AT 6-, 12-, 18- AND 24-MONTHS, AND BRIEF, MONTHLY SURVEYS THAT QUERY THE KEY EXPOSURES AND OUTCOMES IN THE IN-BETWEEN MONTHS. OUR MAIN EXPOSURES WILL BE 1) ALCOHOL USE IN THE PAST 30 DAYS, 2) BINGE DRINKING IN THE PAST 30 DAYS, AND 3) ALCOHOL USE DISORDER. OUR MAIN OUTCOME MEASURES WILL BE: 1) COVID-19 ACQUISITION; 2) THE EXTENT OF AND 3) LENGTH TO WHICH SYMPTOMS ARE EXPERIENCED. FINDINGS WILL HAVE BOTH SHORT- AND LONG-TERM IMPACT ON THE PUBLIC HEALTH RESPONSE TO THIS AND FUTURE PANDEMICS.

IDENTIFYING POSITIVE ASPECTS OF YOUTH INTERNET USE: THE NEXT STEP IN PREVENTION

TEXTING FOR RELAPSE PREVENTION: IMPROVING OUTCOMES FOR PEOPLE WITH SCHIZOPHRENIA

AFFECTING THE EPIDEMIOLOGY OF HIV IN UGANDA THROUGH OLDER ADOLESCENTS

SMOKING CESSATION VIA TEXT MESSAGING: FEASIBILITY TESTING OF SMS USA

CAPITALIZING ON THE POWER OF THE INTERNET TO SURVEY UGANDAN LGBT NATIONALLY

DEVELOPING A BULLYING PREVENTION PROGRAM THAT TRANSCENDS PHYSICAL BOUNDARIES - AN ESTIMATED 20-24% OF MIDDLE SCHOOL STUDENTS BULLY THEIR PEERS ‘REGULARLY’ OR MORE OFTEN EACH SEMESTER. BULLYING INVOLVEMENT IS ASSOCIATED WITH EXTERNALIZING PROBLEMS (E.G., ALCOHOL USE) FOR BULLIES AND INTERNALIZING BEHAVIORS (E.G., DEPRESSIVE SYMPTOMATOLOGY), AND SUICIDAL IDEATION AND BEHAVIOR FOR VICTIMS. EFFORTS TO REDUCE BULLYING PERPETRATION, THEREBY ALSO REDUCING VICTIMIZATION, ARE CRITICAL. EXISTING BULLYING PREVENTION PROGRAMS HAVE ONLY A MODEST IMPACT IN ELEMENTARY SCHOOL SETTINGS AND EVEN LESS OF AN IMPACT IN MIDDLE SCHOOLS. APPROACHES THAT AVOID ADULT INVOLVEMENT AND INTEGRATE LESS PROSCRIPTIVE LANGUAGE MAY HAVE MORE IMPACT ON BEHAVIOR CHANGE. WE BELIEVE TEXT MESSAGING IS ONE SUCH APPROACH AS IT PROVIDES NOVEL OPPORTUNITIES TO “GO WHERE YOUTH ARE”: NEARLY ALL (91%) OF THE NINE IN TEN TEENS WHO OWN CELL PHONES USE TEXT MESSAGING, AND USAGE IS HIGH ACROSS RACE, INCOME, AND RURAL VS. URBAN SETTINGS. CONTENT CAN BE WRITTEN TO BE APPROACHABLE AND NOT SOUND AS IF IT IS BEING DELIVERED BY AN AUTHORITY FIGURE, IMPORTANTLY, EMERGING EVIDENCE SUGGESTS THAT TEXT MESSAGING- BASED PROGRAMS CAN AFFECT BEHAVIOR CHANGE. THIS R21 PROPOSAL IS AN EXTENSION OF OUR DEVELOPMENT WORK WITH BULLYDOWN, A TEXT MESSAGING-BASED BULLYING PREVENTION PROGRAM DESIGNED FOR MIDDLE SCHOOL STUDENTS. GUIDED BY THE SOCIAL-EMOTIONAL LEARNING (SEL) MODEL, THE INTERVENTION CONTENT AND PROGRAM FEATURES HAVE BEEN ITERATIVELY REFINED WITHIN ONGOING FEEDBACK FROM MIDDLE SCHOOL YOUTH FROM ACROSS THE COUNTRY. THE PROGRAM WAS THEN BETA TESTED WITH 22 MIDDLE SCHOOL STUDENTS IN ILLINOIS. NINE IN 10 SAID THEY LIKED THE PROGRAM, AND ALL INTERVENTION PARTICIPANTS SAID THAT IT EQUIPPED THEM WITH SKILLS NEEDED TO NOT BULLY OTHERS IN THE FUTURE. BUILDING UPON OUR PROMISING FINDINGS, WE PROPOSE TO FURTHER DEVELOP AND THEN PILOT TEST BULLYDOWN IN A RANDOMIZED CONTROLLED TRIAL (RCT) OF MIDDLE SCHOOL STUDENTS. SPECIFICALLY, WE AIM TO: SPECIFIC AIM 1: FINALIZE THE BULLYDOWN PROGRAM. FEEDBACK FROM BETA TEST PARTICIPANTS WILL BE INTEGRATED INTO THE INTERVENTION. WE ALSO WILL UPDATE PROGRAM CONTENT TO ACKNOWLEDGE THE GROWING INFUSION OF TECHNOLOGY IN THE CLASSROOM, AND THE ONLINE INTERACTIONS THAT IT REQUIRES. TO DO SO, WE WILL FIRST CONDUCT FOCUS GROUPS TO UNDERSTAND HOW YOUNG PEOPLE ARE INTERACTING WITH EACH OTHER ONLINE IN ACADEMIC SETTINGS. THEN THE UPDATED CONTENT WILL BE REVIEWED BY CONTENT ADVISORY TEAMS TO ENSURE THAT IT IS UNDERSTANDABLE AND SALIENT. SPECIFIC AIM 2: PILOT TEST THE 7-WEEK BULLYDOWN INTERVENTION FOR FEASIBILITY AND ACCEPTABILITY IN AN RCT OF 150 MIDDLE SCHOOL STUDENTS. YOUTH WILL BE RANDOMLY ASSIGNED TO EITHER BULLYDOWN, A 4-MESSAGE- PER-DAY PROGRAM, OR AN ATTENTION-MATCHED CONTROL GROUP TALKING ABOUT ‘HEALTHY LIFESTYLE’ TOPICS (E.G., EXERCISE). OUR MAIN OUTCOME MEASURES WILL BE FEASIBILITY (E.G., RETENTION RATES) AND ACCEPTABILITY (E.G., POSITIVE PROGRAM APPRAISAL). BEHAVIORAL OUTCOMES WILL INFORM POWER ANALYSES, AND INCLUDE BULLYING PERPETRATION.

SMS TURKEY: HARNESSING THE POWER OF TXT MESAGING TO PROMOTE SMOKING CESSATION

IDENTIFYING OPPORTUNITIES TO INTEGRATE TECHNOLOGY INTO HIV PREVENTION FOR SOUTH A