Pacific Institute For Research And Evaluation

ENVIRONMENTAL APPROACHES TO PREVENTION

OJJDP FY 09 ENFORCING UNDERAGE DRINKING LAWS DISCRETIONARY PROGRAM TRAINING AND TECHNICAL ASSISTANCE

RESEARCH ON THE EFFECTS OF AN ANONYMOUS TIP LINE AND MULTIDISCIPLINARY RESPONSE TEAMS IN SCHOOLS ACROSS THE STATE OF NEVADA

A COMMUNITY TRIAL IN ALASKA TO PREVENT YOUTH'S USE OF LEGAL PRODUCTS TO GET HIGH

ETHICS OF HIV-RELATED RESEARCH INVOLVING ADOLESCENTS IN KENYA

ENFORCING UNDERAGE DRINKING LAWS: TRAINING AND TECHNICAL ASSISTANCE (REVIEW CURRENT RESEARCH AND PROGRAMMATIC INNOVATIONS)

STRATEGIES FOR PREVENTING UNDERAGE DRINKING AND OTHER SUBSTANCE USE IN NATIVE AMERICAN TRIBAL COMMUNITIES

A LONGITUDINAL PROSPECTIVE STUDY OF SOCIAL NETWORK DYNAMICS IN ADDICTIONS

SAFER CALIFORNIA COLLEGES AND UNIVERSITIES

CAN CHURCH SCHOOLS REDUCE RISK OF HIV INFECTION FOR ORPHAN GIRLS IN ZIMBABWE?

ENHANCING STRUCTURAL COMPETENCY IN SCHOOL-BASED HEALTH CENTERS TO ADDRESS LGBTQ+ ADOLESCENT HEALTH EQUITY - PROJECT SUMMARY SCHOOL-BASED HEALTH CENTERS (SBHCS) ARE AT THE FRONTLINES OF HEALTHCARE DELIVERY AND PREVENTION SERVICES FOR YOUNG PATIENTS ACROSS THE UNITED STATES. SBHCS PROVIDE VITAL SERVICES TO SCHOOL-AGED YOUTH, INCLUDING BEHAVIORAL, SEXUAL, AND REPRODUCTIVE HEALTHCARE, OFTEN REGARDLESS OF PATIENTS' INSURANCE STATUS OR ABILITY TO PAY. YOUNG PATIENTS WHO ARE GENDER OR SEXUAL MINORITY (GSM) ARE FAR MORE LIKELY TO SUFFER FROM ADVERSE HEALTH OUTCOMES THAN THEIR CISGENDER AND HETEROSEXUAL PEERS. STRUCTURAL OR SOCIETAL-BASED FACTORS (E.G., STIGMA, DISCRIMINATION, LOW AWARENESS OF AND INSENSITIVITY TOWARDS THEIR HEALTH CONCERNS) CONTRIBUTE TO GREATER UNMET NEEDS AND POORER QUALITY OF CARE FOR GSM YOUTH. STRUCTURAL COMPETENCY ADDRESSES THE UPSTREAM FACTORS (SOCIAL DETERMINANTS OF HEALTH, INADEQUATE AND FRAGMENTED TREATMENT, INEQUITIES IN CARE) THAT AFFECT GSM STUDENTS. ENHANCING STRUCTURAL COMPETENCY WITHIN SBHCS WILL IMPROVE THE CARE RECEIVED BY GSM STUDENTS AND, THEREFORE, THEIR HEALTH. EMERGING STRUCTURAL COMPETENCY FRAMEWORKS CALL FOR THE CULTIVATION OF AWARENESS AND CAPACITIES IN SBHCS TO MODIFY ORGANIZATIONAL SERVICE DELIVERY ENVIRONMENTS, INCLUDING PROVIDER AND STAFF KNOWLEDGE AND BEHAVIORS, TO INFLUENCE WELLBEING WITHIN THIS SOCIALLY MARGINALIZED ADOLESCENT POPULATION. NATIONALLY RECOGNIZED RECOMMENDATIONS OR GUIDELINES FOR NURTURING STRUCTURAL COMPETENCY INCLUDE (1) ADOPTION, DISSEMINATION, AND ENFORCEMENT OF GSM SUPPORTIVE POLICIES AND PROCEDURES; (2) CREATION OF WELCOMING PHYSICAL ENVIRONMENTS FOR GSM PATIENTS; (3) SYSTEMATIC DOCUMENTATION AND USE OF SEXUAL ORIENTATION AND GENDER IDENTITY (SOGI) INFORMATION TO INFORM AND IMPROVE CLINICAL SERVICES; (4) ONGOING TRAINING FOR ALL EMPLOYEES IN BEST PRACTICES FOR INTERACTING WITH GSM PATIENTS; AND (5) CLINICAL WORKFORCE DEVELOPMENT TO ENCOURAGE DELIVERY OF HIGH-QUALITY SERVICES TO GSM PATIENTS. THIS COMMUNITY-ENGAGED IMPLEMENTATION SCIENCE STUDY IS SCAFFOLDED BY SCHOOL- AND SBHC-BASED RESEARCH CONDUCTED IN THE RURAL, ECONOMICALLY CHALLENGED, AND CULTURALLY RICH STATE OF NEW MEXICO. THIS RESEARCH PROVIDES A SOLID FOUNDATION FOR EMPLOYING IMPLEMENTATION SCIENCE APPROACHES TO FACILITATE AND EVALUATE THE ADOPTION OF THESE GUIDELINES USING THE DYNAMIC ADAPTATION PROCESS (DAP), A MULTIFACETED IMPLEMENTATION STRATEGY. WE WILL CONDUCT MIXED-METHOD READINESS ASSESSMENTS TO DETERMINE INNER- AND OUTER- CONTEXT DETERMINANTS FOR IMPLEMENTING STRUCTURALLY COMPETENT CHANGES IN SBHCS; USE A STEPPED-WEDGE TRIAL DESIGN TO EXAMINE HOW DAP-ENABLED IMPLEMENTATION IMPACTS THE ADOPTION AND EFFECT OF STRUCTURALLY COMPETENT CHANGES ON SBHC, STUDENT (PATIENT), AND IMPLEMENTATION OUTCOMES; AND ASSESS THE ROLE OF KEY INNER- AND OUTER- CONTEXT DETERMINANTS, BRIDGING FACTORS, AND ASSOCIATED MEDIATORS AND MODERATORS INFLUENCING IMPLEMENTATION PROCESSES AND IMPROVED OUTCOMES FOR GSM STUDENTS. THESE OUTCOMES INCLUDE REDUCED BARRIERS TO CARE AND GREATER SATISFACTION AND ENGAGEMENT IN CARE. THIS STUDY REPRESENTS A KEY STEPPINGSTONE TO ACHIEVING OUR LONG- TERM GOAL OF HIGH-QUALITY CARE AND DECREASED HEALTH AND BEHAVIORAL HEALTH DISPARITIES FOR GSM YOUTH.

SCHOOL SUPPORT AS STRUCTURAL HIV PREVENTION FOR ADOLESCENT ORPHANS IN KENYA

A COMMUNITY-BASED ZT PROGRAM: COMPLETING THE MODEL OF MLDA ENFORCEMENT

WEB-BASED FAMILY PREVENTION OF ALCOHOL AND RISKY SEX FOR OLDER TEENS

IMPLEMENTING SCHOOL NURSING STRATEGIES TO REDUCE LGBTI ADOLESCENT SUICIDE

GROUP-BASED INTERVENTION FOR ALCOHOL, DRUGS AND AGGRESSION AMONG CLUB PATRONS

ASSESSING THE IMPACT OF THE CALIFORNIA ALCOHOL SERVER TRAINING ACT - ABSTRACT ABOUT 50% OF DUI OFFENDERS REPORT THAT THE LAST PLACE THEY DRANK AN ALCOHOLIC BEVERAGE WAS AT A LOCAL BAR OR RESTAURANT, AND HIGHER RATES OF ALCOHOL-RELATED MOTOR VEHICLE CRASHES AND VIOLENCE OCCUR IN COMMUNITIES WITH HIGHER DENSITIES OF LICENSED ON-PREMISES ESTABLISHMENTS SUCH AS BARS AND RESTAURANTS. STUDIES IN VARIOUS LOCATIONS ACROSS THE U.S. ALSO CONSISTENTLY SHOW HIGH RATES OF ALCOHOL SERVICE TO PSEUDO-INTOXICATED PATRONS AT BARS. TO ADDRESS THESE CONTINUING PUBLIC HEALTH PROBLEMS, CALIFORNIA ENACTED THE RESPONSIBLE BEVERAGE SERVICE TRAINING ACT IN 2017 TO DECREASE THE OVER-SERVICE OF ALCOHOL TO INTOXICATED PATRONS AT LICENSED ON- PREMISES ESTABLISHMENTS. RESPONSIBLE BEVERAGE SERVICE (RBS) REFERS TO THE STEPS THAT SERVERS OF ALCOHOLIC BEVERAGES CAN TAKE TO REDUCE THE CHANCES THAT THEIR PATRONS (OR GUESTS) BECOME INTOXICATED, OR FAILING THAT, TO INTERVENE SO AS TO REDUCE THE RISK OF SUBSEQUENT HARM TO THE PATRON OR OTHERS. THE PRIMARY MECHANISM TO ENCOURAGE RESPONSIBLE SERVICE HAS BEEN SOME FORM OF STAFF OR MANAGER TRAINING. TYPICALLY, SUCH TRAINING INCLUDES THE LAWS THAT GOVERN SERVING BEHAVIOR, THE EFFECTS OF ALCOHOL ON THE BODY, RECOGNIZING SIGNS OF INTOXICATION, AND STRATEGIES FOR REFUSING SERVICE TO SOMEONE WHO DISPLAYS THOSE SIGNS. ONE MIGHT SUPPOSE THAT RBS TRAINING WOULD BE AN EFFECTIVE PREVENTION STRATEGY, BUT EVALUATION RESULTS HAVE BEEN MIXED. THE CALIFORNIA RBS TRAINING ACT MANDATES TRAINING FOR ALL ALCOHOL SERVERS BEGINNING IN 2021 GIVING US A RARE OPPORTUNITY TO LOOK MORE CLOSELY AT HOW A STATEWIDE RBS TRAINING INITIATIVE MIGHT INFLUENCE SERVER BEHAVIOR. THE PROPOSED RESEARCH WILL INCLUDE A REPLICATION OF AN EVALUATION OF THE MANDATORY STATEWIDE RBS TRAINING LAW IMPLEMENTED IN OREGON, AS WELL AS A RANDOMIZED TRIAL IN WHICH AN ONLINE RBS TRAINING PROGRAM KNOWN TO BE EFFECTIVE WILL BE USED AS A “BENCHMARK” AGAINST WHICH A COMPARISON GROUP OF “USUAL AND CUSTOMARY” PRACTICES WILL BE MEASURED FOR THE EFFICACY OF THEIR TRAINING. THE SPECIFIC AIMS ARE: (1) TO EVALUATE THE IMPACT OF MANDATORY SERVER TRAINING ON ALCOHOL-RELATED MOTOR VEHICLE CRASHES IN CALIFORNIA; AND (2) TO EVALUATE THE EFFICACY OF “USUAL AND CUSTOMARY” TRAINING WHEN COMPARED TO AN ONLINE TRAINING KNOWN TO BE EFFECTIVE (WAYTOSERVE) ON THE LIKELIHOOD OF REFUSALS TO PSEUDO-PATRONS; (3) TO CONDUCT A STATE-WIDE SURVEY OF OWNERS/MANAGERS OF ALCOHOL OUTLETS THAT WILL HELP IDENTIFY OBSTACLES OR FACILITATORS OF THE NEW SERVER TRAINING LAW. THIS STUDY WILL DETERMINE WHETHER THE STATEWIDE MANDATE IS SUFFICIENT TO REDUCE ALCOHOL-RELATED MOTOR VEHICLE CRASHES, WHETHER “USUAL AND CUSTOMARY” PRACTICES AND TRAINING WILL MATCH THE EFFICACY OF A HIGH-QUALITY ONLINE RBS TRAINING PROGRAM IN IMPROVING ALCOHOL SERVING BEHAVIOR.

MANAGING HEAVY DRINKING TO AVOID IMPAIRED DRIVING: A STUDY OF INTERLOCK USERS

PREVENTING UNDERAGE DRINKING BY SOUTHWEST CALIFORNIA INDIANS

PREVENTION OF YOUNG ADULT DRUG USE IN CLUB SETTINGS

HEALTHY NATIVE NATIONS: IDENTIFYING EFFECTIVE ALCOHOL POLICIES FOR AMERICAN INDIAN TRIBES - ABSTRACT THIS TRIBAL COMMUNITY-ENGAGED PROJECT USES SPATIAL AND LEGAL EPIDEMIOLOGICAL METHODS WITHIN COMMUNITY PARTICIPATORY FRAMEWORKS TO ASSESS THE DIFFERENTIAL RELATIONSHIPS OF STATE AND TRIBAL ALCOHOL POLICIES TO ALCOHOL- RELATED HEALTH RISKS FOR RESIDENTS OF AMERICAN INDIAN RESERVATIONS. WE PROPOSE TO COMPILE AND SUMMARIZE ALCOHOL REGULATORY POLICIES ESTABLISHED BY SOVEREIGN TRIBAL NATIONS IN CONJUNCTION WITH EXTANT ALCOHOL POLICIES OF THE U.S. STATES WITH WHICH THEY ARE COLLOCATED. MANY CORRELATES OF THE HIGH RATES OF ALCOHOL-RELATED PROBLEMS OBSERVED AMONG AMERICAN INDIANS (AI) COMPARED TO OTHER U.S. POPULATIONS HAVE BEEN EXTENSIVELY ADDRESSED IN INDIVIDUAL SOCIAL-BEHAVIORAL STUDIES IN, FOR EXAMPLE, GENETICS, PSYCHOLOGY, AND COMMUNITY HEALTH. VERY FEW STUDIES HAVE CONSIDERED CONTRASTING STATE VS. TRIBAL ALCOHOL POLICIES AS SOCIAL-STRUCTURAL DETERMINANTS THAT MAY BE RELATED TO AI ALCOHOL RELATED PROBLEMS. SOVEREIGN TRIBAL NATIONS HAVE THE RIGHT TO ESTABLISH THEIR OWN ALCOHOL POLICIES, WHICH MAY VARY ACCORDING TO ADJACENT STATE POLICY CONDITIONS AND ATTITUDES TOWARDS ALCOHOL ACROSS TRIBAL COMMUNITIES. TRIBAL ALCOHOL POLICIES ARE PUBLICLY REGISTERED, BUT THERE HAS BEEN NO COMMON REPOSITORY NOR SYSTEMATIC TYPOLOGY ESTABLISHED THAT ALLOWS RESEARCHERS TO CHARACTERIZE THESE ORDINANCES AND RELATE THEM TO STATE ALCOHOL CONDITIONS (SEE, E.G. NIAAA’S ALCOHOL POLICY INFORMATION SYSTEM). PRIOR STUDIES OF TRIBAL ALCOHOL POLICIES WERE NOT ABLE TO CONSIDER THE FULL IMPACTS OF COLLOCATED STATE ALCOHOL REGULATORY CONDITIONS ON TRIBAL ALCOHOL PROBLEMS. RECENT STUDIES HAVE DEVELOPED AN ALCOHOL POLICY SCORE (APS) THAT CHARACTERIZES THE STRENGTHS OF ALCOHOL POLICIES ACROSS U.S. STATES. THE APS MAY NOW BE APPLIED TO STUDIES OF TRIBAL ALCOHOL REGULATORY CONDITIONS. CROSS-SITE STUDIES OF TRIBAL ALCOHOL OUTCOMES HAVE ALSO BEEN HAMPERED BY THE USE OF HETEROGENOUS DATA SYSTEMS. WE DEMONSTRATE THAT HOSPITALIZATION RECORDS AND MOTOR VEHICLE CRASH DATA COLLECTED IN SIMILAR WAYS ACROSS U.S. STATES CAN BE USED TO ASSESS TRIBAL ALCOHOL OUTCOMES USING COMMON DATA FRAMES AND ADVANCED SPATIAL EPIDEMIOLOGICAL METHODS. FINALLY, ANALYSES OF TRIBAL POLICIES WILL BE LIMITED IN INTERPRETIVE SCOPE WITHOUT OBTAINING LOCAL INSIGHTS AND KNOWLEDGE OF TRIBAL LEADERS WHO HAVE DESIGNED, ENACTED, AND ARE CHARGED WITH ENFORCING TRIBAL ALCOHOL ORDINANCES. WE USE TRIBAL COMMUNITY-BASED PARTICIPATORY AND QUALITATIVE RESEARCH METHODS AT MULTIPLE LEVELS OF COMMUNITY ENGAGEMENT (TRIBAL COMMUNITY ADVISORY BOARD; TRIBAL RESEARCH REVIEW; TRIBAL KEY LEADER INTERVIEW; TRIBAL AND LOCAL LAW ENFORCEMENT SURVEY) TO ASSESS HOW TRIBAL AND STATE ALCOHOL POLICIES ARE EFFECTED ON TRIBAL LANDS AND MAY SUPPORT OR REDUCE ALCOHOL-RELATED RISKS FOR RESIDENTS OF TRIBAL NATIONS. OUR ENGAGEMENT PLANS ENSURE TRIBAL COMMUNITY OVERSIGHT OF THE INTERPRETATION OF FINDINGS, AND DISSEMINATION OF RESULTS TO TRIBAL LEADERS AS WELL AS SCIENTIFIC COMMUNITIES.

PRE- TO POST-IMMIGRATION DRINKING AND DRIVING AMONG RECENT LATINO IMMIGRANTS: EXAMINING OPPORTUNITIES FOR INTERVENTION

ENVIRONMENTAL DRINKING CONTEXTS & INTIMATE PARTNER VIOLENCE

OTC SYRINGE SALES TO PREVENT HIV IN UNDERSERVED AREAS OF INLAND CALIFORNIA

STATEWIDE IMPLEMENTATION OF SEXUAL ORIENTATION AND GENDER IDENTITY (SOGI) DATA COLLECTION TO ADVANCE HEALTH EQUITY - ABSTRACT NATIONAL HEALTH AUTHORITIES POINT TO COLLECTING SEXUAL ORIENTATION AND GENDER IDENTITY (SOGI) DATA AS ESSENTIAL TO SYSTEMATICALLY ADDRESSING THE HEALTH AND HEALTHCARE NEEDS OF SEXUAL- AND GENDER-DIVERSE (SGD) PEOPLE ACROSS ALL DOMAINS OF LIFE. THE STATE OF NEW MEXICO ANSWERED THIS CALL BY DIRECTING ALL ITS GOVERNMENT AGENCIES, INCLUDING THOSE OVERSEEING OR FINANCING HEALTH AND HUMAN SERVICE DELIVERY, TO COLLECT VOLUNTARY SELF-REPORTED SOGI DATA. THESE VITAL (A) ILLUMINATE THE NATURE AND EXTENT OF DISPARITIES AND ADVERSE HEALTH OUTCOMES FOR A MINORITIZED POPULATION, (B) ENCOURAGE PATIENT-CENTERED CARE, AND (C) DEVELOP EQUITY-FOCUSED EVIDENCE-BASED INTERVENTIONS (EFEBIS) TO ELIMINATE LONG-STANDING DISPARITIES. NEW MEXICO IS A BELLWETHER FOR OTHER STATES WANTING TO ROUTINIZE PROCESSES FOR ROBUST DEMOGRAPHIC ANALYSES OF SGD PEOPLE, ENHANCE COORDINATION OF HEALTH SERVICES, GUIDE POLICY AND FUNDING DECISIONS, ADVANCE EFEBIS FOR THEIR VARIED CITIZENRIES AND MONITOR PROGRESS TOWARD HEALTH EQUITY FOR SGD PEOPLE. NEW MEXICO'S HEALTH DEPARTMENT (NMHEALTH) OPERATES 53 PUBLIC HEALTH OFFICES (PHOS)— IDEAL SETTINGS FOR ANALYZING THE UPTAKE AND SUSTAINMENT OF SOGI DATA COLLECTION. STAFFED IN LARGE PART BY NURSES, PHOS ARE A CRITICAL SAFETY NET FOR RACIALLY, ETHNICALLY, AND GEOGRAPHICALLY DIVERSE COMMUNITIES IN NEW MEXICO, OFFERING A WIDE RANGE OF HEALTH SERVICES, FROM IMMUNIZATIONS, FAMILY PLANNING, NUTRITIONAL PROGRAMMING, SUBSTANCE USE HARM REDUCTION, TESTING AND TREATMENT FOR SEXUALLY TRANSMITTED INFECTIONS, CANCER PREVENTION AND CONTROL, AND OTHER MEDICAL CARE ACROSS THE LIFESPAN. THIS MULTILEVEL, MIXED-METHOD R01 STUDY WILL TEST THE ACCEPTABILITY, APPROPRIATENESS, AND FEASIBILITY OF IMPLEMENTATION STRATEGIES IN PHOS TO ENABLE SOGI DATA COLLECTION WITH DIFFERENT POPULATIONS AND IN URBAN, RURAL, AND FRONTIER CONTEXTS. GUIDED BY THE INTERACTIVE SYSTEMS FRAMEWORK, OUR INTERDISCIPLINARY TEAM WILL (1) ASSESS GAPS IN IMPLEMENTATION READINESS TO ENGAGE IN ACCURATE, RELIABLE, AND USABLE SOGI MEASUREMENT IN PHOS; AND APPLY IMPLEMENTATION MAPPING TO SYSTEMATICALLY SELECT AND TAILOR IMPLEMENTATION STRATEGIES TO ADDRESS BARRIERS; (2) DEPLOY AND EVALUATE IDENTIFIED IMPLEMENTATION STRATEGIES TO ENABLE SOGI DATA COLLECTION IN PHOS IN A SEQUENTIAL MULTIPLE ASSIGNMENT RANDOMIZED TRIAL (SMART); AND (3) USE THE DISCOVER, DESIGN, BUILD, AND TEST FRAMEWORK TO DEVELOP AN ONLINE TOOLKIT INTEGRATING MANUALIZED IMPLEMENTATION STRATEGY RESOURCES TO DISSEMINATE SOGI DATA COLLECTION IN SERVICE DELIVERY SETTINGS. OUR TEAM OF RESEARCHERS, HEALTHCARE PROVIDERS, AND PATIENT ADVOCATES ARE POISED TO FOSTER USE OF IMPLEMENTATION STRATEGIES FOR INCLUSIVE SOGI DATA COLLECTION, SO THE STATE AND NATION ARE PREPARED TO IDENTIFY, ANALYZE, AND ADVANCE EFEBIS TO INTERVENE IN THE ALARMING DISPARITIES NEGATIVELY SHAPING SGD HEALTH AND WELL-BEING. THROUGH THE INNOVATIVE USE OF MODELS AND METHODS FROM DISSEMINATION AND IMPLEMENTATION SCIENCE, OUR TEAM'S OVERALL GOAL IS TO TACKLE A LONG-RUNNING, PERPLEXING PROBLEM—THE RAMPANT DEFICIENCIES IN STATE-SPONSORED DATA COLLECTION SYSTEMS THAT ABET THE INVISIBILITY OF SGD PEOPLE IN PUBLIC HEALTH, MEDICAL, AND HUMAN SERVICE RECORDS, THWART THE DEVELOPMENT OF EFEBIS, AND BUTTRESS POOR HEALTH OUTCOMES.

IMPROVING NATIVE AMERICAN ELDER ACCESS TO AND USE OF HEALTHCARE THROUGH EFFECTIVE HEALTH SYSTEM NAVIGATION

FOCUS ON INTEGRATING RESPONSE, SCREENING, AND TRAINING (FIRST) FOR WOMEN IN KENTUCKY - THE PACIFIC INSTITUTE FOR RESEARCH AND EVALUATION (PIRE), A NATIONAL RESEARCH AND EVALUATION CENTER WITH EXPERTISE IN SUBSTANCE USE DISORDER (SUD) AND INTIMATE PARTNER VIOLENCE (IPV) PROPOSES THE FOCUS ON INTEGRATING RESPONSE, SCREENING, AND STAFF TRAINING (FIRST) FOR WOMEN IN KENTUCKY (KY) TO: (1) CREATE A COMMUNITY OF PRACTICE CONNECTED TO THE KY COALITION AGAINST DOMESTIC VIOLENCE (KCADV) AND THE KY CABINET FOR HEALTH AND FAMILY SERVICES, BRANCH OF ADULT SUBSTANCE USE TREATMENT AND RECOVERY SERVICES (ASUTRS), (2) IMPLEMENT INTERSECTIONAL, TRAUMA-INFORMED TRAINING FOR EACH OF KY'S REGIONAL SUD TREATMENT AND IPV SERVICES PROVIDERS, UTILIZING BEST PRACTICES FOR ADDRESSING THE INTERSECTION OF MOTHERHOOD, IPV, AND SUD, AND (3) EXPAND IPV AND SUD PARTNERSHIPS AND WORKFORCE TO INCLUDE LOCAL MEDICAL PRACTITIONERS. KCADV, WHICH SUPPORTS KY’S 15 REGIONAL IPV SERVICE PROVIDERS, AND ASUTRS, WHICH DIRECTS THE 14 SUD SERVICE PROGRAMS IN EACH REGION, WILL PROVIDE IN-KIND SERVICES TO IMPROVE INFRASTRUCTURE AND CROSS-COLLABORATION AS WELL AS INCENTIVIZE SERVICE PROVIDERS. A THIRD PARTNER, PROVIDE INC. WILL DEVELOP TRAINING TO DECREASE PROVIDER STIGMA RELATED TO IPV AND SUD. EFFORTS WILL ALSO INTEGRATE SUD AND IPV BEST PRACTICES AND REFERRAL PROTOCOLS INTO MEDICAL PRACTICE BY BUILDING ON ONGOING WORK IN THE KY PERINATAL QUALITY COLLABORATIVE PROGRAM. THE THEORY OF SOCIAL SUPPORT UNDERLIES OUR APPROACH; INCREASING SUPPORTS FOR SERVICE PROVIDERS’ AS WELL AS REDUCING PROVIDER STIGMA WILL ENABLE PROVIDERS TO OFFER WOMEN SUPPORTS THROUGH SCREENING AND REFERRAL SERVICES. OUR WORK WILL BE INFORMED BY EXISTING REGIONAL COLLABORATIVE COMMUNITY WORK GROUPS AS WELL AS EVIDENCE-BASED CURRICULA. PIRE’S EXPERTISE IN BOTH IMPLEMENTATION SCIENCE AND COMMUNITY-BASED EVALUATION WILL ENABLE US TO IMPLEMENT A ROBUST PROCESS AND OUTCOMES EVALUATION AND ASSIST EACH KY REGION IN DEVELOPING A DISPARITY IMPACT STATEMENT TO ADDRESS THE INTERSECTING NEEDS OF WOMEN EXPERIENCING VIOLENCE IN THEIR COMMUNITIES.

MULTI-METHOD ETHNOGRAPHIC ASSESSMENT OF BEHAVIORAL HEALTH REFORM IN NEW MEXICO

THE ROLE OF LOCAL STRUCTURAL STIGMA IN ALCOHOL RELATED INEQUITIES AMONG SGM YOUNG ADULTS - ABSTRACT NOTICE NUMBER: NOT-MD-19-001. SEXUAL AND GENDER MINORITY (SGM) POPULATIONS HAVE AMONG THE HIGHEST RATES OF ALCOHOL USE, HAZARDOUS DRINKING, AND USE DISORDERS IN THE UNITED STATES. A LARGE BODY OF LITERATURE SUGGESTS THAT STIGMA AND MINORITY STRESS ARE PRIMARY FACTORS DRIVING SGM INEQUITIES. SGM STIGMA IS THE SOCIAL PROCESS OF LABELING, STEREOTYPING, AND REJECTING HUMAN DIFFERENCE AS A FORM OF SOCIAL CONTROL AND IT OPERATES AT THREE LEVELS: (1) STRUCTURAL STIGMA (E.G., SOCIETAL NORMS AND INSTITUTIONAL LAWS AND PRACTICES THAT LIMIT THE RESOURCES OF STIGMATIZED PEOPLE); (2) INTERPERSONAL STIGMA (E.G., VERBAL HARASSMENT AND PHYSICAL VIOLENCE); AND (3) INDIVIDUAL STIGMA (E.G., THE FEELINGS PEOPLE HOLD ABOUT THEMSELVES OR THE BELIEFS THEY PERCEIVE OTHERS HOLD ABOUT THEM THAT MAY SHAPE ANTICIPATION AND AVOIDANCE OF DISCRIMINATION). CRUCIAL GAPS REMAIN IN THE LITERATURE OF SGM STIGMA AND ALCOHOL USE. FIRST, STRUCTURAL STIGMA HAS LARGELY BEEN MEASURED AND EXAMINED AT THE NATIONAL OR STATE LEVEL. YET, STRUCTURAL STIGMA EXPERIENCED AT THE LOCAL LEVEL (E.G., CITY POLICIES) MAY BE CRUCIAL IN UNDERSTANDING THE MECHANISMS BY WHICH STIGMA INFLUENCES SGM HEALTH. TO DATE, RESEARCH ON THE ASSOCIATIONS BETWEEN LOCAL STRUCTURAL STIGMA AND ALCOHOL USE IS LIMITED. SECOND, STUDIES HAVE YET TO EXAMINE HOW STRUCTURAL STIGMA IS ASSOCIATED WITH INTERPERSONAL AND INDIVIDUAL STIGMAS. THIRD, SCANT RESEARCH HAS EXAMINED HOW THE INTERSECTIONS OF THESE STIGMAS IMPACT SGM ALCOHOL INEQUITIES. WE THEREFORE PROPOSE TO INVESTIGATE THE RELATIONSHIPS OF LOCAL STRUCTURAL STIGMA AND EXPERIENCES OF DISCRIMINATION WITH SGM YOUNG ADULTS' ALCOHOL USE AND RELATED PROBLEMS. THE STUDY WILL BE CONDUCTED IN 33 MIDSIZED CITIES IN CALIFORNIA THAT CONTAIN SIGNIFICANT VARIATION IN PARTICIPANTS' EXPOSURE TO LOCAL STRUCTURAL SIGMA. TO ASSESS LOCAL STRUCTURAL STIGMA, INCLUDING ITS SPECIFIC COMPONENTS (E.G., LAW ENFORCEMENT, MUNICIPAL BENEFITS AND PROTECTIONS TO LGBTQ EMPLOYEES), WE WILL USE INFORMATION AND RATINGS ASSESSED BY THE HUMAN RIGHTS CAMPAIGN. FOURTEEN CONSECUTIVE DAILY SURVEYS WITH 792 SGM YOUNG ADULTS (AGES 18-29, 24 PER CITY, FOR A TOTAL OF 7,084 ESTIMATED DATA POINTS) WILL BE USED TO ASSESS PARTICIPANTS' DAY-TO-DAY EXPERIENCES WITH STIGMAS AND ALCOHOL USE OUTCOMES. A BASELINE SURVEY WILL ASSESS DEMOGRAPHICS, ALCOHOL USE, EXPERIENCES WITH DISCRIMINATION, AND CONSTRUCTS OF MINORITY STRESS. SINCE GENDER MINORITIES (GM), CISGENDER SEXUAL MINORITIES (SM) WOMEN, AND YOUNG PEOPLE OF DIFFERENT RACIAL/ETHNIC GROUPS MAY EXPERIENCE HIGHER LEVELS OF STIGMA THAN OTHER SGM GROUPS, IT IS NECESSARY TO CONSIDER DIFFERENCES WITHIN SGM POPULATIONS. THE SPECIFIC AIMS ARE TO: (1) ASSESS ASSOCIATIONS OF LOCAL STRUCTURAL SGM STIGMA AND EXPERIENCES OF INTERPERSONAL DISCRIMINATION WITH ALCOHOL USE, HAZARDOUS DRINKING, AND ALCOHOL-RELATED PROBLEMS (E.G., ALCOHOL USE DISORDER SYMPTOMS), (2) EXAMINE THE MECHANISMS THROUGH WHICH LOCAL STRUCTURAL, INTERPERSONAL, AND INDIVIDUAL STIGMAS ARE ASSOCIATED WITH ALCOHOL USE, HAZARDOUS DRINKING, AND ALCOHOL-RELATED PROBLEMS, AND (3) EXPLORE WHETHER THE RESULTS FOR AIM 1 DIFFER BY CISGENDER SM MEN, CISGENDER SM WOMEN, GM POPULATIONS, AND LATINXS. WE FOCUS ON LATINX SGMS AS THE LARGEST RACIAL/ETHNIC GROUP IN CALIFORNIA (~40%).

CHANGING ENVIRONMENTAL INFLUENCES ON ADOLESCENT ALCOHOL USE AND RISK BEHAVIORS

SCHOOL-BASED HEALTH CLINICS: EFFECTS ON YOUTH AND YOUNG ADULT SEXUAL BEHAVIOR

SOCIAL, FAMILIAL, NEIGHBORHOOD FACTORS AND DRINKING IN PUERTO RICO

COMMUNITY ALCOHOL OUTLET DENSITY, DRUNKEN DRIVING AND VIOLENCE: CORE GROUP THEORY

NEIGHBORHOODS, ALCOHOL OUTLETS AND INTIMATE PARTNER VIOLENCE

HIV/STD PREVENTION PROGRAM FOR AFRICAN AMERICAN MALES

LOCAL TOBACCO POLICY AND YOUTH SMOKING

EVALUATION OF ALCOHOLEDU: A RANDOMIZED MULTI-CAMPUS STUDY

ALBUQUERQUE-BERNALILLO COUNTY YOUTH UNDERAGE DRINKING & RX OPIOID MISUSE PREVENTION PARTNERSHIP (ABC PREVENT)

IMPACTS OF OFF-PREMISE ALCOHOL OUTLETS ON LOCAL NEIGHBORHOOD ALCOHOL PROBLEMS

CULTIVATING HEALING BY IMPLEMENTING RESTORATIVE PRACTICES FOR YOUTH (CHIRPY)

LGBT ADULTS AND TOBACCO STIGMA: A QUALITATIVE STUDY

HIV/STD PREVENTION FOR HIGH-RISK YOUTH IN LIBERIA

PREVENTING UNDERAGE DRINKING BY SOUTHWEST CALIFORNIA INDIANS: BUILDING CAPACITY

YOUTH ALCOHOL USE AND RISKY SEXUAL BEHAVIOR IN BANGKOK

TRANSLATING DRINKING AND DRIVING RISK INFORMATION INTO RISK PERCEPTION

BARRIERS TO ALCOHOL, DRUG AND PTSD TREATMENT FOR RETURNING NATIONAL GUARD

ADOLESCENT FAMILY-BASED ALCOHOL PREVENTION

IMPROVING THE HEALTH OF CAMBODIAN AMERICAN WOMEN: A CBPR APPROACH

IVDIRM: A NEW METHODOLOGY FOR EXAMINING DRUG- AND ALCOHOL-IMPAIRED DRIVING

DRIVERS WITH ALCOHOL USE DISORDERS: AT HIGH RISK FOR CRASHES?

RURAL COMMUNITIES OPIOID RESPONSE-IMPLEMENTATION

FORMATION OF AN IMPAIRED-DRIVING CENTER

IMPROVING RELATIONSHIP OUTCOMES USING CULTURAL COMPETENCE & COMMUNICATION TRAINING FOR MENTORS AND ENHANCED MATCH SUPPORT

DRINKING PATTERNS AT CLUBS: USING ORAL ASSAYS AND PORTAL METHODOLOGY

ASSISTANCE TO FIREFIGHTERS GRANT

ADOLESCENTS' USE OF SOCIAL AND COMMERCIAL SOURCES OF ALCOHOL

EFFECT OF ALCOHOL PLACEMENTS IN TELEVISION PROGRAMMING

PARTNER VIOLENCE: ROLES OF WORK, JOB STRESS & DRINKING

YOUNG ADULT FOOD SERVICE WORKERS: ALCOHOL USE & RISK

MODERATING SOCIAL NORMS INTERVENTIONS: FIELD EXPERIMENT

ADDRESSING HIGH SCHOOL MARIJUANA USE IN CONTEXT OF INCREASING SOCIAL ACCEPTANCE

DEVELOPING A PEER ADVOCATE INTERVENTION FOR RURAL LGBT POPULATIONS

IHELP: INTERACTIVE TECHNOLOGY TO PREVENT SUBSTANCE USE IN FOSTER YOUTH

PREVENTING HIV RISK AMONG ADOLESCENT ORPHANS IN KENYA

A SIMULATION OF TOBACCO POLICY, SMOKING AND LUNG CANCER

MENTAL ILLNESS AND COMMUNITY REENTRY IN A MULTI-ETHNIC POPULATION OF FEMALE INMAT

DEFINING THE ROLE OF MEXICAN PHARMACIES IN HIV PREVENTION-A MIXED METHOD APPROACH

ORGANIZATIONAL FACTORS IN DRUG ABUSE TREATMENT OUTCOMES

ENCOURAGING SAFE DATES: REDUCING INTIMATE PARTNER VIOLENCE IN SOUTH AFRICAN YOUTH

DEVELOPMENT OF A DIGITAL INTERVENTION TO ADDRESS STIGMA AMONG PREGNANT UNMARRIED ADOLESCENTS LIVING WITH HIV - PROJECT SUMMARY/ABSTRACT KENYA IS ONE OF FEW COUNTRIES BURDENED BY A COMBINATION OF HIGH RATES OF MOTHER-TO-CHILD TRANSMISSION (MTCT) OF HIV, LARGE NUMBERS OF ADOLESCENTS LIVING WITH HIV (ALHIV), AND ELEVATED ADOLESCENT FERTILITY RATES. PREGNANT ALHIV ARE LESS LIKELY THAN ADULTS TO ATTEND ANTENATAL CARE CLINICS AND TO RECEIVE PREVENTION OF MTCT (PMTCT) SERVICES, THEREBY CONTRIBUTING TO THE HIGH MTCT RATE. PREVIOUS WORK AMONG 15-19-YEAR-OLD KENYAN ALHIV, INCLUDING SOME WHO WERE PREGNANT, FOUND THAT STIGMA, UNDISCLOSED HIV STATUS, AND LACK OF SOCIAL SUPPORT MAY BE KEY BARRIERS TO ENGAGEMENT IN PMTCT SERVICES. THUS, ADDRESSING BARRIERS TO DISCLOSURE AND SOCIAL SUPPORT MAY MITIGATE HARMFUL EFFECTS OF THE INTERSECTING STIGMAS OF HIV AND PREGNANCY ON HEALTH OUTCOMES. ALTHOUGH MIXED, STUDY FINDINGS SUGGEST THAT MHEALTH INTERVENTIONS THAT USE TEXT MESSAGING (SMS) MAY IMPROVE PMTCT OUTCOMES. THEY ARE, HOWEVER, LIMITED IN THEIR ABILITY TO FACILITATE BEHAVIOR CHANGE VIA SUPPORT MECHANISMS OR SKILL DEVELOPMENT. GROWING EVIDENCE HIGHLIGHTS THE PROMISE OF DIGITAL INTERVENTIONS AS IMPORTANT TOOLS FOR IMPROVING HIV OUTCOMES AND COMMUNICATION WITH PARENTS. HOWEVER, DIGITAL INTERVENTIONS TO ADDRESS THE EFFECTS OF STIGMA HAVE NOT BEEN EXPLORED AMONG PREGNANT ALHIV. THIS STUDY WILL BUILD ON PREVIOUS WORK AND DRAW ON AN INTEGRATED CONCEPTUAL FRAMEWORK TO DEVELOP AND EVALUATE A DIGITAL INTERVENTION FOR PREGNANT UNMARRIED ALHIV. THE INTERVENTION WILL INCLUDE SMS FOR REMINDER PURPOSES AND WEB-BASED VIRTUAL SIMULATIONS, GAMIFIED ELEMENTS, AND DIDACTIC CONTENT TO EDUCATE AND BUILD RELEVANT STIGMA-RELATED SKILLS. ACCEPTABLE APPROACHES WILL BE IDENTIFIED TO INVOLVE FAMILY CAREGIVERS IN ADDRESSING THE DETRIMENTAL EFFECTS OF THE INTERSECTING STIGMAS ON PREGNANT ALHIV. FAMILY CAREGIVERS ARE AN IMPORTANT YET UNDERAPPRECIATED AND UNDERSTUDIED SOURCE OF SOCIAL SUPPORT FOR PREGNANT UNMARRIED ALHIV. TOGETHER, THESE ARE EXPECTED TO IMPROVE ENGAGEMENT IN PMTCT SERVICES AMONG PREGNANT ALHIV. THE STUDY SPECIFIC AIMS ARE TO: (1) DEVELOP AND EVALUATE A DIGITAL INTERVENTION FOR PREGNANT UNMARRIED ALHIV AGED 15-19 TO INCREASE AWARENESS OF STIGMA AND ITS CONSEQUENCES; IMPROVE DISCLOSURE SELF-EFFICACY AND SKILLS; AND FACILITATE ENLISTMENT OF FAMILY CAREGIVERS AS SOCIAL SUPPORT ALLIES TO ENHANCE UPTAKE OF PMTCT SERVICES; AND (2) IDENTIFY ACCEPTABLE APPROACHES TO INCREASE AWARENESS ABOUT STIGMA AND ENHANCE SKILLS IN COMMUNICATION AND PROVISION OF SOCIAL SUPPORT AMONG FAMILY CAREGIVERS. WE WILL USE DATA FROM INDIVIDUAL INTERVIEWS WITH PREGNANT ALHIV AND JOINT INTERVIEWS WITH PREGNANT ALHIV/CAREGIVER DYADS TO DEVELOP INITIAL INTERVENTION SPECIFICATIONS AND MOCK-UPS. WE WILL THEN CONDUCT FOCUS GROUP TO OBTAIN FEEDBACK ON SAMPLE MATERIALS IN ORDER TO REFINE THE MATERIALS AND DEVELOP AN INTERVENTION PROTOTYPE. WE WILL THEN CONDUCT A PILOT TO EVALUATE ACCEPTABILITY, USABILITY, AND PRELIMINARY EFFICACY OF THE PROTOTYPE. WE WILL CONDUCT FOCUS GROUPS WITH CAREGIVERS TO IDENTIFY ACCEPTABLE APPROACHES TO INVOLVE THEM. DATA WILL BE USED TO FINALIZE CONTENT AND SPECIFICATIONS OF THE DIGITAL INTERVENTION FOR PREGNANT ALHIV AND WILL PROVIDE THE FRAMEWORK FOR A FUTURE COMPLEMENTARY INTERVENTION FOR CAREGIVERS, WHICH WILL BOTH BE TESTED IN A LARGER R34 OR R01 TRIAL.

COLLEGE FACILITATION FOR ALCOHOL PROBLEMS

21ST CENTURY POLICING: CROSS-SITE, MULTI-STAKEHOLDER SENTINEL EVENT REVIEW PROJECT

DWI: TARGETED RISK FOR BETTER TARGETED POLICIES

DEVELOPING AND IMPLEMENTING A TOOL TO EVALUATE AND IMPROVE UNDERAGE DRINKING AND DRIVING POLICIES

ASSESSING THE IMPACT OF PARENTAL CHARACTERISTICS, PARENTAL ATTITUDES, AND PARENTAL ENGAGEMENT ON MENTORING RELATIONSHIP OUTCOMES

ASSESSING THE DEVELOPMENT OF DRUG MARKETS USING BAYESIAN SPACE-TIME MODELS

RURAL COMMUNITIES OPIOID RESPONSE PROGRAM-PSYCHOSTIMULANT SUPPORT

DRINKING AND DRIVING AMONG RECENT LATINO IMMIGRANTS

LATINO MIGRANT LABORERS' USE OF DRUG ABUSE RECOVERY HOUSES

EFFECTS OF IMPAIRED-DRIVING CRASHES ON THE U.S. ECONOMY

PARAMEDIC-ADMINISTERED BUPRENORPHINE AS A BRIDGE TO MEDICATION-ASSISTED TREATMENT

COMPARING MULTIPLE METHODS OF MEASURING FIDELITY OF CURRICULUM IMPLEMENTATION

ENHANCING PRIMARY CARE SERVICES FOR DIVERSE SEXUAL AND GENDER MINORITY POPULATIONS

CHARACTERIZING PRESCRIPTION DRUG USE IN A REPRESENTATIVE SAMPLE OF U.S. DRIVERS

PATHWAYS TO HIV RISK AMONG ORPHAN SCHOOL DROPOUTS IN KENYA

REQUIRING DUI OFFENDERS TO INSTALL AN INTERLOCK TO REINSTATE: EFFECTIVE?

LEGAL RESEARCH ON THE EFFECTS OF UNDERAGE DRINKING

DRUNK DRIVING WITH CHILDREN: PUTTING THE BRAKES ON A DISTURBING TREND

TESTING ALCOHOL PREVENTION STRATEGIES USING HIGH VALIDITY-FIELD EXPERIMENTS

PROMOTING ENGAGEMENT IN HIV SERVICES AMONG ADOLESCENTS IN KENYA

RELATIONSHIP OF IMPAIRED DRIVING ENFORCEMENT INTENSITY TO DRINKING AND DRIVING

COVID-19 TELEHEALTH POLICIES' IMPACT ON PROVISION OF ALCOHOL AND SUBSTANCE USE DISORDER SERVICES AT FEDERALLY QUALIFIED HEALTH CENTERS - ABSTRACT IN THE UNITED STATES, ALCOHOL AND SUBSTANCE USE DISORDERS (AUD AND SUD) ARE HIGHLY PREVALENT AND ARE ESTABLISHED CAUSES OF MORTALITY, MORBIDITY, INDIVIDUAL AND SOCIETAL COSTS. THERE IS SIGNIFICANT UNMET NEED IN ACCESSIBLE AUD AND SUD TREATMENT OPTIONS, HOWEVER TELEHEALTH IS DEMONSTRATED TO BE AN EFFECTIVE SOLUTION TO ADDRESSING BARRIERS TO TREATMENT, ESPECIALLY FOR UNDERSERVED POPULATIONS. THE COVID-19 PANDEMIC NECESSITATED A RAPID PIVOT TO TELEHEALTH BY ADAPTING AVAILABLE TECHNOLOGIES AND DEREGULATING TELEHEALTH USE AS A REPLACEMENT TO IN-PERSON SERVICES. ADOPTION OF TELEHEALTH FOR AUD AND SUD TREATMENT MAY BE PARTICULARLY ADVANTAGEOUS FOR ADDRESSING ISSUES OF ACCESS FOR MEDICALLY UNDERSERVED POPULATIONS, SUCH AS THOSE SERVED BY FEDERALLY QUALIFIED HEALTH CENTERS (FQHCS). RESULTS WILL IDENTIFY TELEHEALTH POLICIES (I.E., AUDIO-ONLY TELEHEALTH, PROVIDER TYPE EXPANSION, SERVICE TYPE EXPANSION) THAT WERE EFFECTIVE DURING THE PANDEMIC TO INFORM LASTING CHANGES TO HEALTH SYSTEMS IMPROVING ACCESS TO AUD AND SUD SERVICES. THE CENTRAL HYPOTHESIS IS THAT POLICIES SUPPORTING TELEHEALTH DURING COVID-19 WILL BE POSITIVELY ASSOCIATED WITH INCREASED AUD AND SUD SERVICE UTILIZATION IN UNDERSERVED POPULATIONS. OUR SPECIFIC AIMS ARE AS FOLLOWS: 1. CONDUCT LEGAL ANALYSIS OF STATE MEDICAID COVID- 19 TELEHEALTH POLICIES; 2. EVALUATE STATE MEDICAID TELEHEALTH POLICIES ON AUD AND SUD SERVICE UTILIZATION AT FQHCS, AND 3. ANALYZE IMPACT OF STATE MEDICAID COVID-19 TELEHEALTH POLICIES ON FQHC SPECIAL POPULATIONS. THE STUDY WILL EMPLOY THE CENTER FOR CONNECTED HEALTH POLICY'S POLICY FINDER RESOURCE FOR COVID-19 TELEHEALTH POLICY DATA AND FQHC PROGRAM DATA FOR OUTCOME DATA ON PATIENT CHARACTERISTICS (E.G., DEMOGRAPHIC INFORMATION) AND SERVICES PROVIDED (E.G., NUMBER OF VISITS AND NUMBER OF PATIENTS FOR AUD AND SUD SERVICES). WE WILL CONDUCT A SERIES OF DIFFERENCES-IN-DIFFERENCES MODELS AND USE OTHER ANALYTIC METHODS USING LONGITUDINAL DATA TO COMPARE CATEGORIZED TELEHEALTH POLICIES DEVELOPED THROUGH LEGAL RESEARCH ON STATE MEDICAID TELEHEALTH POLICIES. THE AIMS OF THE PROPOSED STUDY ARE INHERENTLY INNOVATIVE AS THE TELEHEALTH POLICY CHANGES RESULTING FROM THE COVID-19 PANDEMIC ARE NOVEL AND PRESENT A UNIQUE OPPORTUNITY TO EVALUATE THE IMPACT OF TELEHEALTH ON AUD AND SUD ACCESS AND UTILIZATION, PARTICULARLY FOR UNDERSERVED POPULATIONS. IDENTIFYING POLICIES THAT IMPROVE ACCESS TO AUD AND SUD CARE AND TREATMENT WILL HAVE LASTING AND SIGNIFICANT IMPLICATIONS FOR HEALTH SERVICES AFTER THE PANDEMIC, SUCH AS PERMANENT POLICY ADOPTION OR APPLICATION TO DIFFERENT PAYORS, SETTINGS, AND POPULATIONS.

EXTENDING THE EFFECTIVENESS OF VEHICLE ALCOHOL INTERLOCKS

EFFECTIVENESS OF .08 AND .05 BAC LIMITS FOR DRIVING

ECONOMIC IMPACT OF COMBAT-RELATED INJURIES FROM THE WARS IN IRAQ AND AFGHANISTAN

LONGITUDINAL STUDY OF MECHANISMS OF DRUG ABUSE RECOVERY-PILOT

ALCOHOL OUTLET PRIVATIZATION: THE BRITISH COLUMBIA EXPERIMENT

HEALTH INTERVENTIONS WITH INTERLOCK USERS: EFFECTIVE?

CHILD ENDANGERMENT AND TRAFFIC SAFETY

IMPACT OF THE NEW ZEALAND MINIMUM DRINKING AGE ON CONTEXT SPECIFIC DRINKING RISKS

THE PARC EDUCATION PROGRAM FOR FIRST DUIS: TWO-YEAR FOLLOWUP OF 43,000 OFFENDERS

EVALUATION OF A COMMUNITY-BASED INITIATIVE TO PREVENT OPIOID OVERDOSE

IMPLEMENTING STRUCTURALLY COMPETENT CRITICAL TIME INTERVENTION FOR TRANSGENDER AND GENDER-DIVERSE PATIENTS - PROJECT SUMMARY THE APPROXIMATELY 1.6 MILLION AMERICANS WHO ARE TRANSGENDER OR GENDER DIVERSE (TGD)—INDIVIDUALS WITH GENDER IDENTITIES THAT DIFFER FROM THEIR SEX ASSIGNED AT BIRTH—ARE IMPACTED BY AN EXTRAORDINARILY HIGH INCIDENCE OF NEGATIVE MENTAL AND PHYSICAL HEALTH OUTCOMES COMPARED TO THEIR CISGENDER PEERS. SUCH OUTCOMES INCLUDE MENTAL DISTRESS, SUICIDE, SUBSTANCE USE ISSUES, AND HIV AND OTHER SEXUALLY TRANSMITTED INFECTIONS. THESE HEALTH INEQUITIES ARE ATTRIBUTABLE TO “UPSTREAM” OR STRUCTURAL FACTORS, INCLUDING SYSTEMATIC SOCIETAL, POLITICAL, AND ECONOMIC MARGINALIZATION, MEDICAL PATHOLOGIZATION, AND VIOLENCE. RESEARCH POINTS TO RAMPANT MULTILEVEL ACCESS BARRIERS FOR TGD PEOPLE AND MAJOR SOCIAL NEEDS THAT UNDERMINE ENGAGEMENT IN HEALTHCARE. THERE IS A PUBLIC HEALTH IMPERATIVE TO DEVELOP HEALTHCARE INTERVENTIONS TO REDUCE DISPARITIES FOR TGD PEOPLE BY FACILITATING ACCESS TO AND ENGAGEMENT WITH APPROPRIATE SERVICES, ADDRESSING THEIR UNIQUE SOCIAL DETERMINANTS OF HEALTH (SDOH), AND INTEGRATING THEM INTO THE SOCIAL FABRIC OF COMMUNITIES. STRUCTURAL INTERVENTIONS TARGET THE SOCIAL CAUSES OF ILL- HEALTH, INADEQUATE AND FRAGMENTED TREATMENT, AND INEQUALITIES AFFECTING TGD PEOPLE. IN PARTNERSHIP WITH TGD COMMUNITY MEMBERS, WE CREATED A STRUCTURALLY COMPETENT ADAPTATION OF THE EVIDENCE-BASED CRITICAL TIME INTERVENTION (CTI), A ROBUST CASE MANAGEMENT PROGRAM ORIGINALLY DEVELOPED FOR PERSONS WITH SERIOUS MENTAL ILLNESS TRANSITIONING FROM INSTITUTIONS INTO COMMUNITIES, TO AMELIORATE THE DISPARITIES THAT IMPEDE THE FULL INTEGRATION OF TGD PEOPLE INTO HEALTHCARE SYSTEMS. WE WILL RIGOROUSLY IMPLEMENT AND EVALUATE THIS TGD-SPECIFIC ADAPTATION (CTI-T) IN NEW MEXICO SERVICE SYSTEMS AND ANALYZE IMPACTS ON TGD PEOPLE EXITING INSTITUTIONAL SETTINGS, INCLUDING SHELTER CARE AND RESIDENTIAL PROGRAMS, HOSPITALS, AND JAILS/PRISONS. WE WILL CULTIVATE MEANINGFUL COLLABORATION AND INCLUSION OF DIVERSE PARTNERS TO ENABLE STRUCTURAL COMPETENCY AND CTI-T UPTAKE AT THE MULTIPLE LEVELS WHERE CARE BARRIERS EXIST BY APPLYING IMPLEMENTATION MAPPING, A PARTICIPATORY PROCESS FOR PLANNING AND SELECTING IMPLEMENTATION STRATEGIES (METHODS TO ADOPT AND IMPLEMENT INTERVENTIONS). WE WILL LEVERAGE A SEMINAL IMPLEMENTATION MODEL, THE INTERACTIVE SYSTEMS FRAMEWORK, TO GUIDE EFFORTS TO EMBED CTI-T IN PROFESSIONAL SERVICE DELIVERY CONTEXTS. A REAL-TIME EVALUATION OF IMPLEMENTATION AND IMPACT USING A MIXED-METHODS APPROACH WILL FACILITATE DUAL TESTING OF THE CTI-T AND ITS IMPLEMENTATION STRATEGIES. BY INNOVATING CTI TO PRIORITIZE STRUCTURALLY COMPETENT APPROACHES, THIS STUDY RESPONDS TO THE DEARTH OF EVIDENCE-BASED INTERVENTION RESEARCH TARGETING THE SDOH RESPONSIBLE FOR THE WELL-DOCUMENTED ACCESS BARRIERS AND EXCESSIVE MORBIDITY AND MORTALITY FACED BY TGD PEOPLE.

FAMILY STRENGTHS IN PREVENTING ADOLESCENT DRUG USE

LIFETIME DRINKING PATTERNS & HCV TREATMENT OUTCOMES

ASSESSING ALTERNATIVE PROTOCOLS FOR UNDERAGE ALCOHOL SALES COMPLIANCE CHECKS

LIBERIA SCHOOL-BASED HIV/STD PREVENTION PROGRAM

EXPLORATION OF ALCOHOL INTERLOCK, BIOMARKER AND PSYCHOMETRIC DATA

MOBILIZING THE COMMUNITY TO REDUCE TEEN PRESCRIPTION DRUG ABUSE

EFFECTS OF STEREOTYPE THREAT ON THE HEALTH-RELATED OUTCOMES OF AFRICAN AMERICANS

ALCOHOL AND OTHER DRUGS: CRASH RISK FOR DIFFERENT GROUPS OF DRIVERS

ETHNIC DIFFERENCES IN DRINKING AND DIABETES SELF CARE ACTIVITIES

BORDER GIRLS: AOD USE, ABUSE, AND VICTIMIZATION

TRANSITIONING YOUTH INTO LONG-HAUL TRANSPORTATION INDUSTRY EMPLOYMENT

COMPETITION TO PREVENT HIGH-RISK DRINKING & VIOLENT BEHAVIOR AMONG COLLEGE STUDENTS

STRATEGIES FOR PREVENTING UNDERAGE DRINKING AND OTHER SUBSTANCE USE IN NATIVE AMERICAN TRIBAL COMMUNITIES

CHANGING LANES, CHANGING TIMES ? THE RISKS FACING FEMALE DRIVERS TODAY

ADMINISTRATIVE LICENSE SUSPENSION: DOES LENGTH OF SUSPENSION MATTER

ALONG FOR THE RIDE. PASSENGERS RIDING WITH IMPAIRED DRINKING DRIVERS

AN EVALUATION OF THE NIGHT RESTRICTION AND PASSENGER LIMITATION COMPONENTS OF GRA

ASSOCIATIONS OF YOUTH E-CIG AND TOBACCO USE: ECOLOGICAL MOMENTARY ASSESSMENT

RURAL COMMUNITIES OPIOID RESPONSE (PLANNING)

STATISTICAL MODELING OF MEDICATION AND PLACEBO EFFECTS

FAMILY PLANNING CLINICS AND ADOLESCENT SEXUAL BEHAVIOR

PLACE-BASED STRENGTHS AND VULNERABILITIES FOR MENTAL WELLNESS AMONG RURAL MINORITY SENIORS - PROJECT SUMMARY SEVERE INEQUITIES IN DEPRESSION AND ITS DIAGNOSIS AND TREATMENT AMONG RURAL-DWELLING, RACIAL/ETHNIC MINORITY SENIORS COMPARED TO THEIR URBAN WHITE COUNTERPARTS RESULT IN INCREASED MORTALITY, COGNITIVE IMPAIRMENT, AND MULTIPLE CO-MORBIDITIES, THUS PRESENTING A GROWING PUBLIC HEALTH CONCERN AS THE UNITED STATES POPULATION AGES. THESE HEALTH INEQUITIES ARE OFTEN ATTRIBUTABLE TO SOCIAL AND ENVIRONMENTAL FACTORS, INCLUDING ECONOMIC INSECURITY, HISTORIES OF TRAUMA, CHRONIC GAPS IN TRANSPORTATION AND SAFETY-NET SERVICES (E.G., FOOD ASSISTANCE, HEALTH CARE), AND DISPARITIES IN ACCESS TO POLICYMAKING PROCESSES ROOTED IN COLONIALISM THAT MAKE THESE GROUPS “STRUCTURALLY VULNERABLE” TO MENTAL ILL HEALTH. FEWER DATA EXIST ON PROTECTIVE FACTORS ASSOCIATED WITH SOCIAL AND ENVIRONMENTAL CONTEXTS, SUCH AS PROXIMITY OF SOCIAL SUPPORT, COMMUNITY ATTACHMENT, AND A MEANINGFUL SENSE OF PLACE. WHILE THE IMPORTANCE OF SUCH PLACE-BASED FACTORS IS WIDELY RECOGNIZED IN SCHOLARSHIP ON THE SOCIAL DETERMINANTS OF HEALTH, THERE IS TO DATE LITTLE RESEARCH SPECIFICALLY EXAMINING HOW SUCH FACTORS SHAPE DISPARITIES IN DEPRESSION AND TREATMENT, AS WELL AS LIMITED PRACTICAL APPROACHES TO TARGET THESE FACTORS AND THEIR EFFECTS ON MENTAL WELLBEING FOR RURAL AND MINORITY POPULATIONS. THIS K99/R00 APPLICATION PROPOSES TO INTEGRATE MY EXPERTISE AS A CULTURAL ANTHROPOLOGIST IN PARTICIPATORY QUALITATIVE RESEARCH AND IMPLEMENTATION SCIENCE WITH NEW KNOWLEDGE IN RURAL MENTAL HEALTH RESEARCH, QUANTITATIVE AND MIXED-METHOD DESIGNS, AND INTERVENTION DEVELOPMENT, IN ORDER TO CONCEPTUALIZE AND INTERVENE ON THE SOCIAL AND ENVIRONMENTAL CAUSES OF MENTAL HEALTH DISPARITIES. COURSEWORK, WORKSHOPS, AND THE EXPERTISE OF AN INTERDISCIPLINARY TEAM OF MENTORS AT THE PACIFIC INSTITUTE FOR RESEARCH AND EVALUATION AND THE UNIVERSITY OF NEW MEXICO DURING THE K99 PERIOD WILL PROVIDE ME WITH THE SKILLS TO UNDERTAKE THE PROPOSED R00 RESEARCH, WHICH WILL UTILIZE QUANTITATIVE SURVEYS, QUALITATIVE INTERVIEWS, ECOLOGICAL NETWORK RESEARCH, AND SPATIAL DATA ANALYSIS TO ELUCIDATE HOW PLACE-BASED VULNERABILITIES AND PROTECTIVE FACTORS SHAPE EXPERIENCES OF DEPRESSION AMONG RURAL AMERICAN INDIAN AND LATINX ELDERS IN NEW MEXICO. GUIDED BY INTERVENTION MAPPING, A PARTICIPATORY APPROACH FOR PLANNING HEALTH INTERVENTIONS, DATA WILL CONTRIBUTE TO A COMMUNITY-DRIVEN PLAN FOR A MULTISYSTEM INTERVENTION TARGETING THE PLACE-BASED CAUSES OF DISPARITIES IN DEPRESSION, WHICH WILL FORM THE BASIS OF A SUBSEQUENT R01 IMPLEMENTATION AND EVALUATION STUDY. THIS PARTICIPATORY AND INTERDISCIPLINARY STUDY WILL ELUCIDATE HOW AXES OF DIFFERENCE PERTAINING TO PLACE, RURALITY, AND MINORITY STATUS DRIVE MENTAL HEALTH DISPARITIES. THE RESULTING PLACE-FOCUSED INTERVENTION PLAN WILL IMPROVE MENTAL HEALTH EQUITY FOR AGING POPULATIONS THAT DATA SHOW ARE SEVERELY AND PERSISTENTLY UNDERSERVED AND ADVANCE THE SCIENCE OF INTERVENTION AND IMPLEMENTATION BEYOND ITS PREDOMINANT FOCUS ON INDIVIDUALS AND HEALTHCARE SETTINGS. DATA AND TRAINING WILL CONTRIBUTE TO MY INDEPENDENCE AS AN INVESTIGATOR FOCUSED ON THE SOCIAL CAUSES OF HEALTH DISPARITIES AND TRANSLATE DIRECTLY INTO FUTURE NIH-FUNDED RESEARCH TARGETING THE UPSTREAM CAUSES OF MENTAL HEALTH DISPARITIES IN THIS AND OTHER UNDERSERVED POPULATIONS.

ASKDOKI: EVALUATION OF A MOBILE HEALTH INTERVENTION TO IMPROVE SEXUAL AND REPRODUCTIVE HEALTH OUTCOMES AMONG KENYAN ADOLESCENTS LIVING INURBAN INFORMAL SETTLEMENTS - ABSTRACT/PROJECT SUMMARY DESPITE RECENT IMPROVEMENTS IN ADOLESCENT SEXUAL AND REPRODUCTIVE HEALTH (ASRH) OUTCOMES IN KENYA, RATES OF UNSAFE SEX, UNPLANNED PREGNANCY, ABORTION, AND SEXUALLY TRANSMITTED INFECTIONS REMAIN HIGH. WHILE SCHOOLBASED COMPREHENSIVE SEXUALITY EDUCATION (CSE) IMPROVES ASRH OUTCOMES, THE KENYAN GOVERNMENT TENDS TO SUPPORT LESS THOROUGH PROGRAMS, AND TEACHERS FACE CHALLENGES (E.G., LACK OF TIME, TRAINING, RESOURCES) THAT HINDER SEXUALITY EDUCATION INSTRUCTION. ADOLESCENTS WHO DO NOT RECEIVE ADEQUATE CSE INSTRUCTION LACK THE INFORMATION NEEDED TO MAKE INFORMED SEXUAL AND REPRODUCTIVE HEALTH DECISIONS. THUS, THERE IS PRESSING NEED TO IDENTIFY INNOVATIVE INTERVENTIONS TO PROVIDE CSE OUTSIDE THE FORMAL EDUCATIONAL SYSTEM. MOBILE HEALTH (MHEALTH) TECHNOLOGY MAY PROVIDE A COST-EFFECTIVE SOLUTION. AMREF HEALTH AFRICA–KENYA DEVELOPED/TESTED AN ARTIFICIALLY INTELLIGENT MHEALTH WHATSAPP CHAT BOT, ASKDOKI, TO DELIVER CSE. PRELIMINARY DATA SUGGEST IMPROVED EFFECTIVENESS AND OUTREACH MIGHT BE OBTAINED, ESPECIALLY AMONG ADOLESCENTS WHO LACK PHONES, BY PAIRING ASKDOKI WITH “TECH SAVVY” YOUTH PEER LEADERS OR “DIGITAL CHAMPIONS” (DCS). IN COLLABORATION WITH AMREF, WE WILL IMPLEMENT ASKDOKI AMONG ADOLESCENTS VIA DC OUTREACH AND FACILITATION TO ADDRESS OUR SPECIFIC AIMS: R21 AIM 1A) EXAMINE THE EFFECTIVENESS OF ASKDOKI-DELIVERED CSE IN IMPROVING KEY DETERMINANTS OF ASRH BEHAVIORS/ OUTCOMES VIA A QUASI-EXPERIMENTAL, TWO-GROUP (INTERVENTION VS. CONTROL CLUSTERS), NON-EQUIVALENT, PRE/POST SURVEY DESIGN WITH ADOLESCENTS AGED 15-19. PRIMARY OUTCOMES FOR COMPARISON WILL BE INCREASES IN PERCEIVED CONTROL (E.G., CONDOM-USE SELF-EFFICACY), POSITIVE ATTITUDES (E.G., CONDOM USE), SUBJECTIVE NORMS (E.G., PEER SUPPORT OF CONDOM USE), KNOWLEDGE (E.G., PREGNANCY, STIS), AND INTENTIONS (E.G., TO USE CONDOMS). R21 AIM 1B) CONDUCT A PROCESS EVALUATION OF THE DC STRATEGY TO PROMOTE/FACILITATE ASKDOKI ACCESS. WE WILL COLLECT DATA FROM MULTIPLE SOURCES TO ASSESS ADOLESCENT REACH, ACCEPTABILITY, AND UPTAKE OF THE DC STRATEGY. WE WILL ALSO CONDUCT TWO SETS OF FOCUS GROUPS: WITH AIM 1A ADOLESCENTS TO EXPLORE DC PERCEPTIONS AND EXPERIENCES AND TO IDENTIFY IMPROVEMENT AREAS; AND WITH DCS TO EXPLORE BARRIERS AND FACILITATORS. R21 AIM 2) CONDUCT COST EFFECTIVENESS ANALYSES FOR THE ASKDOKI AND DC STRATEGY. WE WILL TRACK START-UP, OPERATIONAL, AND INCREMENTAL PER-USE COSTS AND COMPUTE COST PER ADOLESCENT SERVED AND COST PER ADOLESCENT WHO MAKES PROGRESS ON ONE AND ON AT LEAST THREE OUTCOME MEASURES. R33 AIM 3) EVALUATE A SCALED DEPLOYMENT OF ASKDOKI USING RE-AIM FRAMEWORK. WE WILL EXAMINE REACH (ADOLESCENTS ACCESSING ASKDOKI), EFFECTIVENESS (AIM 1 OUTCOMES, CONDOM USE, PREGNANCY REDUCTION, WILLINGNESS TO TEST/TREAT STIS, USE OF SRH SERVICES); ADOPTION (REPRESENTATIVENESS OF ASKDOKI USERS, CHARACTERISTICS OF CURRICULUM COMPLETERS); IMPLEMENTATION (INTERVIEWS WITH ADOLESCENTS TO EXPLORE BARRIERS, FACILITATORS, SCALED DEPLOYMENT COST); AND MAINTENANCE (SUSTAINED EFFECTIVENESS OF PRIMARY/SECONDARY OUTCOMES). FINDINGS MAY INFORM SCALABLE INTERVENTIONS THAT PROVIDE U.S. ADOLESCENTS WITH HEALTH INFORMATION THAT ULTIMATELY HELPS TO IMPROVE YOUTH OUTCOMES.

THE EFFECT OF STATE CHILD LABOR LAWS ON ADOLESCENT WORK INTENSITY AND ALCOHOL USE

PREVENTING FASD: THE IMPLEMENTATION AND IMPACT OF STATE POLICIES

EFFECTS OF THREE UNDERAGE DRINKING LAWS ON YOUTH TRAFFIC FATALITIES

A MARRIAGE SAVED IS A PENNY EARNED: THE ECONOMIC BENEFITS OF MARRIAGE EDUCATION PROGRAMS

NEIGHBORHOOD CONTEXT, DRUG USE, AND RISKY SEXUAL BEHAVIOR AMONG U.S. ADOLESCENTS

RURAL COMMUNITIES OPIOID RESPONSE (PLANNING)