Testing pathways linking exposure to community violence and sexual behaviors among African American youth

"The Fight is Two Times as Hard": A Qualitative Examination of a Violence Syndemic Among Young Black Sexual Minority Men

Young Black men who have sex with men (YBMSM) are disproportionately impacted by violence, including violence rooted in anti-Black racism, sexual identity bullying, and neighborhood violence rooted in structural racism and inequities. These multiple forms of violence are frequently co-occurring and interactive creating syndemic conditions that can negatively impact HIV care. This qualitative study is based on in-depth interviews with 31 YBMSM, aged 16-30 years, living with HIV in Chicago, IL, to examine how violence has impacted their lives. Using thematic analysis, we identified five themes that reflect how YBMSM experience violence at the intersection of racism, homonegativity, socioeconomic status, and HIV status: (a) the experience of intersectional violence; (b) long histories of violence contributed to hypervigilance, lack of safety, and lack of trust; (c) making meaning of violence and the importance of strength; (d) normalizing violence for survival; and (e) the cyclical nature of violence. Our study highlights how multiple forms of violence can accumulate across an individual's life and contribute to social and contextual situations that further contribute to violence and negatively impact mental health and HIV care.

Social environment risk factors for violence, family context, and trajectories of social-emotional functioning among Latinx adolescents

INTRODUCTION

High social-emotional functioning, including emotion regulation and nonviolent conflict resolution, constitute developmental competencies of adolescence that promote health and well-being. We used prospective longitudinal data from a predominantly Latinx population to understand how family context and social environment risk factors for violence related to patterns of social-emotional functioning during the transition between middle school and high school.

METHODS

We prospectively interviewed 599 8th graders every 6 months for 2 years. We used trajectory models to explore longitudinal patterns of emotion regulation and nonviolent problem solving and multinomial regression to distinguish how these groups were associated with family context, partner and peer gang involvement, and neighborhood social disorder.

RESULTS

Youth reporting lower neighborhood disorder in 8th grade were more likely to be in the high emotion regulation trajectory group. Youth without exposure to gangs through peers and partners in 8th grade were more likely to be in the high nonviolent problem-solving skills trajectory group. Family cohesion was associated with being in the high trajectory groups for both emotional regulation and problem-solving skills.

CONCLUSION

Emotion regulation and nonviolent problem-solving skills had different associations with the social environment risk factors for violence examined, indicating that mechanisms of influence and strategies for intervention may vary. The association between problem-solving skills and exposure to gangs through peers and partners shows that social norms may be important targets of change. Additionally, interventions with parents that build family cohesion during adolescence may buffer environmental exposures that shape adolescents' ability to practice protective social-emotional behaviors.

Efficacy to avoid violence and parenting: A moderated mediation of violence exposure for African American urban-dwelling boys

We took a risk and resilience approach to investigating how witnessing physical violence influences adolescent violent behaviors overtime. We proposed efficacy to avoid violence as a major path of influence in this negative trajectory of adolescent development. We also focus on the protective roles of parenting behaviors for African American boys living in disadvantaged contexts. Most of our sample of 310 African American adolescent males (M age = 13.50, SD = .620) had experienced significant amounts of violence, but they also reported continued efficacy to avoid violence. We tested a first stage dual moderated mediation model and found that higher levels of witnessing violence lead to more violent behavior and less efficacy to avoid violence, and that efficacy was the mediator in that link. Youth who witness more violence may feel that engagement in violence is inescapable and thus may themselves end up engaging in it. These problematic long-term trajectories were moderated by parent's communication about violence and monitoring revealing possible protections for youth, and an enhancement of youths' internal strengths. Our findings propose pathways that can inform interventions that may protect African American adolescent boys against the vicious cycle of exposure to, and acts of, violence.

A Systematic Review of Neighborhood-Level Influences on HIV Vulnerability

A better understanding of the social-structural factors that influence HIV vulnerability is crucial to achieve the goal of ending the HIV epidemic by 2030. Given the role of neighborhoods in HIV outcomes, synthesis of findings from such research is key to inform efforts toward HIV eradication. We conducted a systematic review to examine the relationship between neighborhood-level factors (e.g., poverty) and HIV vulnerability (via sexual behaviors and substance use). We searched six electronic databases for studies published from January 1, 2007 through November 30, 2017 (PROSPERO CRD42018084384). We also mapped the studies' geographic distribution to determine whether they aligned with high HIV prevalence areas and/or the "Ending the HIV Epidemic: A Plan for the United States". Fifty-five articles met inclusion criteria. Neighborhood disadvantage, whether measured objectively or subjectively, is one of the most robust correlates of HIV vulnerability. Tests of associations more consistently documented a relationship between neighborhood-level factors and drug use than sexual risk behaviors. There was limited geographic distribution of the studies, with a paucity of research in several counties and states where HIV incidence/prevalence is a concern. Neighborhood influences on HIV vulnerability are the consequence of centuries-old laws, policies and practices that maintain racialized inequities (e.g., racial residential segregation, inequitable urban housing policies). We will not eradicate HIV without multi-level, neighborhood-based approaches to undo these injustices. Our findings inform future research, interventions and policies.

Taking a Critical Look at Adolescent Research on Black Girls and Women: A Systematic Review

In the field of adolescent development, the language, theoretical frameworks, methods for collecting and analyzing data, and ways of interpretation that researchers use may advance notions of white supremacy and perpetuate racist ideas. Understanding how researchers study Black girls and women, in particular, is a critical step in working toward the production of science and knowledge that promotes an anti-racist and anti-sexist agenda and centers the voices of historically marginalized adolescents. Accordingly, we engaged in a systematic review (k = 48) with the goal of taking a critical look at how researchers study Black girls and women. Our synthesis of empirical articles from four prominent adolescent research journals published between 2010 and 2020 revealed themes related to (a) a dearth of critical theoretical frameworks, (b) a lack of acknowledgment of the intersectional experiences of Black girls and women, (c) differences in how researchers incorporate ethnic/racial information, (d) the use of a deficit perspective, and (e) the dominance of quantitative designs. We discuss these themes and conclude with recommendations for incorporating critical frameworks and more varied methodologies, issuing a call for adolescent development scholars to take a deeper, asset-based, and more critical approach to studying Black girls and their development.

Community Violence Exposure and Adolescent Pregnancy in Chicago

This study examined the association between community violence exposure (CVE), sex without contraception, and adolescent pregnancy in Chicago. A self-administered, online survey was conducted among 15- to 19-year-old girls from the South and West sides of Chicago from October to March 2018. Participants were recruited via community organization partnerships and social media advertising. The survey included questions about CVE, sexual behaviors, and covariates that are known to contribute to sexual risk taking. CVE was measured via a validated index of seven questions that measured individual experiences with violence. Multivariable and logistic regression analyses were performed to examine the association between CVE, penile-vaginal intercourse without contraception, and ever being pregnant. The final sample included 644 girls. Levels of CVE were high: 62.87% of girls reported that a close friend or relative died because of violence and 41.60% were a victim of violence. Nearly half (48.69%) of girls had penile-vaginal intercourse and 6.01% had been pregnant. For each standard deviation increase in CVE score, the odds of penile-vaginal intercourse without contraception (odds ratio [OR] = 1.69, 95% confidence interval [CI] = [1.27, 2.25]) and the odds of ever being pregnant (OR = 1.87, 95% CI = [1.36, 2.57]) increased. These results remained significant when adjusting for demographic, psychosocial, institutional, and interpersonal factors. Findings suggest that girls in Chicago who are exposed to higher levels of community violence have an increased likelihood of experiencing penile-vaginal intercourse without contraception and teenage pregnancy, even when adjusting for other predictors to teenage pregnancy.

The Relationship Between Violence Syndemics and Sexual Risk Behaviors Among African American Adolescents: Implications for Future Research

PURPOSE

We present a conceptual framework based on a review of the literature to highlight the interconnecting and reinforcing elements of a violence syndemic and how this syndemic influences sexual risk behaviors among African American heterosexual adolescents.

METHODS

We review existing peer-reviewed published research from 2000 to 2020 that links a violence syndemic (i.e., racism and race-related stress, neighborhood and police violence, peer violence, and family violence and disruptions) to adolescent sexual risk behaviors. Empirical findings and theoretical underpinnings are used to document this relationship and illuminate the factors that mediate this relationship.

RESULTS

Empirical studies support the links between specific types of violence and sexual risk behaviors among African American adolescents. Further, existing studies point to the important relationships among the specific types of violence, supporting a violence syndemic approach.

CONCLUSIONS

While more researchers are examining socio-ecological contextual factors as important predictors for sexual risk behaviors, there remains inadequate understanding about how violence types reinforce one another to heighten sexual risk behaviors among African American heterosexual adolescents. This article presents new directions for adolescent research, especially how a violence syndemic approach can be used to explain sexual risk, but also to refocus intervention design on the complex burdens experienced by this population.

Conceptualizing the Effects of Continuous Traumatic Violence on HIV Continuum of Care Outcomes for Young Black Men Who Have Sex with Men in the United States

The United States (US) is on track to achieve the 90-90-90 targets set forth by UNAIDS and the National HIV/AIDS strategy, yet significant racial disparities in HIV care outcomes remain, particularly for young Black men who have sex with men (YBMSM). Research has demonstrated that various types of violence are key aspects of syndemics that contribute to disparities in HIV risk. However, little research has looked collectively at cumulative violent experiences and how those might affect HIV treatment and care outcomes. Drawing on extant literature and theoretical underpinnings of syndemics, we provide a conceptual model that highlights how continuous traumatic violence experienced by YBMSM may affect HIV outcomes and contribute to racial disparities in HIV outcomes. The findings of this focused review suggest a need for research on how continuous exposure to various types of violence influence HIV prevention and treatment outcomes for young Black MSM.

Posttraumatic Stress, Academic Performance, and Future Orientation as Pathways to Community Violence Exposure and Sexual Risk among African American Youth in Chicago's Southside

Posttraumatic stress, low academic performance, and future orientation as pathways from community violence exposure to sexual risk-taking behavior were examined among 753 African American youth in a large urban school district, ranging from ages of 13 to 24 years. Youth completed a self-report instrument. Youth completed a self-report instrument of Exposure to Violence Probe, University of California at Los Angeles' PTSD Reaction Index Adolescent Version, and Coopersmith's Self-Esteem Scale. Structural equation modeling was performed to examine relationships among the major study variables. Results indicated that community violence exposure was not directly associated with sexual risk behavior. However, community violence exposure had a significantly positive impact on posttraumatic stress, which was associated with low future orientation and sexual risk behavior. Findings suggest that targeted interventions need to consider variables that mediate the association between violence exposure and sexual risk behavior, which can reduce poor sexual health outcomes among urban youth who are exposed to violence in their community.

Exposure to Community Homicide During Pregnancy and Adverse Birth Outcomes: A Within-Community Matched Design

BACKGROUND

Community violence is an understudied aspect of social context that may affect risk of preterm birth and small-for-gestational age (SGA).

METHODS

We matched California mothers with live singleton births who were exposed to a homicide in their Census tract of residence in 2007-2011 to unexposed mothers within the same tract. We estimated risk differences with a weighted linear probability model, with weights corresponding to the matched data structure. We estimated the average treatment effect on the treated of homicide exposure on the risk of preterm birth and SGA during the preconception period and first and second trimester.

RESULTS

We found a small increase in risk of SGA associated with homicide exposure in the first trimester (0.14% [95% confidence interval (CI) = -0.01%, 0.30%]), but not for exposure during the preconception period (-0.01% [95% CI = -0.17%, 0.15%]) or the second trimester (-0.06% [95% CI = -0.23%, 0.11%]). Risk of preterm birth was not affected by homicide exposure. When women were exposed to homicides during all three exposure windows, there was a larger increase in risk of SGA (1.09% [95% CI = 0.15%, 2.03%]) but not preterm birth (0.14% [95% CI = -0.74%, 1.01%]). Exposure to three or more homicides was also associated with greater risk of SGA (0.78% [95% CI = 0.15%, 1.40%]). Negative controls indicated that residual confounding by temporal patterning was unlikely.

CONCLUSIONS

Homicide exposure during early pregnancy is associated with a small increased risk of SGA.

Integrating Individual and Contextual Factors to Explain Disparities in HIV/STI Among Heterosexual African American Youth: A Contemporary Literature Review and Social Ecological Model

Heterosexual African American youth face substantial disparities in sexual health consequences such as HIV and STI. Based on the social ecological framework, the current paper provides a comprehensive, narrative review of the past 14 years of literature examining HIV/STI risk, including risky sexual behavior, among heterosexual African American youth and a conceptual model of risk among this population. The review found that individual psychological and biological factors are insufficient to explain the sexual health disparities faced by this group; instead, structural disadvantage, interpersonal risk, and community dysfunction contribute to the disparity in HIV/STI outcomes directly and indirectly through individual psychological factors. The conceptual model presented suggests that for African American youth, (1) HIV/STI risk commonly begins at the structural level and trickles down to the community, social, and individual levels, (2) risk works in a positive feedback system such that downstream effects compound the influence of structural risks, and (3) contextual and individual risk factors must be considered within the advanced stage of the epidemic facing this population. Despite advanced HIV and STI epidemics among heterosexual African American youth, multisystemic interventions that target structural risk factors and their downstream effects are posited to reduce the disparity among this high-risk population.

Mediation of Firearm Violence and Preterm Birth by Pregnancy Complications and Health Behaviors: Addressing Structural and Postexposure Confounding

Firearm violence may indirectly affect health among pregnant women living in neighborhoods where it is endemic. We used birth, death, emergency department, and hospitalization data from California from 2007-2011 to estimate the association between living in a neighborhood with high firearm violence and preterm delivery, and assessed whether there was mediation by diagnoses of pregnancy complications and health behaviors during pregnancy. We used an ensemble machine learning algorithm to predict the propensity for neighborhoods to be classified as having a high level of firearm violence. Risk differences for the total effect and stochastic direct and indirect effects were estimated using targeted maximum likelihood. Residence in high-violence neighborhoods was associated with higher prevalence of preterm birth (risk difference (RD) = 0.46, 95% confidence interval (CI): 0.13, 0.80), infections (RD = 1.34, 95% CI: -0.17, 2.86), asthma (RD = 0.76, 95% CI: 0.03, 1.48), and substance use (RD = 0.74, 95% CI: 0.00, 1.47). The largest indirect effects for the association between violence and preterm birth were observed for infection (stochastic indirect effect = 0.04, 95% CI: 0.00, 0.08) and substance use (stochastic indirect effect = 0.04, 95% CI: 0.01, 0.06). Firearm violence was associated with risk of preterm delivery, and this association was partially mediated by infection and substance use.

Social Networks Moderate the Syndemic Effect of Psychosocial and Structural Factors on HIV Risk Among Young Black Transgender Women and Men who have Sex with Men

The interaction between the cumulative effect of psychosocial and structural factors (i.e. syndemic effect) and social networks among young Black transgender women and men who have sex with men (YBTM) remains understudied. A representative cohort of 16-29 year-old YBTM (n = 618) was assessed for syndemic factors [i.e. substance use; community violence; depression; poverty; justice system involvement (JSI)], social network characteristics, condomless anal sex (CAS), group sex (GS), and HIV-infection. The syndemic index significantly increased the odds of CAS, GS, and HIV-infection, and these effects were moderated by network characteristics. Network JSI buffered the effect on CAS, romantic network members buffered the effect on GS, and network age and proportion of family network members buffered the effect on HIV-infection. The proportion of friend network members augmented the effect on GS and HIV-infection. Future research to prevent HIV among YBTM should consider social network approaches that target both structural and psychosocial syndemic factors.

Violence Exposure and Sexual Risk Behaviors for African American Adolescent Girls: The Protective Role of Natural Mentorship and Organizational Religious Involvement

African American adolescent girls are at increased risk of being exposed to community violence and being diagnosed with a sexually transmitted infection. Fewer studies, however, have examined the protective roles of natural mentorship and organizational religious involvement as potential moderators that could lessen the effects of violence exposure on health risk behavior. Data from 273 African American ninth grade girls were used to test hypothesized independent and moderated-moderation models. Results suggest that natural mentorship and religious involvement were protective for girls who reported at least one mentor and moderate to high levels of religious involvement. Our findings may be relevant for community stakeholders and organizations that directly interact with religious institutions and community programs that focus on outreach to African American adolescent girls.

Violence Exposure, Drug Use and HIV/AIDS Risk Taking Behaviors: The Role of Gender

OBJECTIVE

To examine gender differences among African American young adults in their exposure to violence (ETV) before age 18 and community violence as an adult, and the relationship of these exposures to drug use and HIV risk taking behaviors (HIVRTB).

METHOD

We detail these experiences in 440 self-identified African Americans, ages 18 to 25, from socio-economically disadvantaged wards in Washington, DC. Factor analysis was used to identify the types of violence experienced before age 18 and as adults. Regression was used to identify which types of violence had the greatest impact on subsequent drug use and HIVRTB.

RESULTS

We found gender differences in the types of violence experienced and their effects on drug use and HIVRTB. For women, the strongest ETV factors were direct personal violence, and exposure to drug sales or physical violence as adults. For men, the strongest factors were feeling unsafe in different situations as adults and exposure to violence among adults before age 18.

CONCLUSIONS

We identified the specific kinds of violence that are most likely to impact drug use and risky sexual behaviors that can leave one vulnerable to HIV and how these differ between women and men exposed to both childhood violence and community violence as an adult. Our findings point toward the need for trauma-informed programs that are tailored to gender.

Neighborhood Crime and Sexual Transmission Risk Behavior among Black Men Living with HIV

Here, we examined the association of exposure to neighborhood crime with sexual risk-taking behavior among Black men living with HIV. HIV-positive Black men on antiretroviral therapy in California completed an audio computer-assisted self-interview. Crime risk per census block group was derived from the Federal Bureau of Investigation's Uniform Crime Report. Among 193 men, the mean (SD) number of sexual partners among those who were sexually active was 2.7 (3.3). 49% reported condomless sex, and 23% reported sex with an HIV-negative or unknown-serostatus partner. In multivariate analysis, illicit drug use ([IRR=1.86; 95%CI: 1.20-2.89] p=.006), depressive symptoms ([IRR=1.59; 95%CI: 1.03-2.44] p=.03), an undetectable viral load ([IRR=1.91; 95%CI: 1.22-3.00] p=.005), and neighborhood total crime risk ([IRR=1.02; 95%CI: 1.01-1.04] p=.007) remained significant. Among Black men living with HIV, exposure to neighborhood crime is associated with having multiple sexual partners whose HIV status was negative or unknown.

"Running Trains" and "Sexing-In": The Functions of Sex Within Adolescent Gangs

Gang members are exposed to unique sexual risks, yet little work has explored the influence of gang social norms. This study examines the functions and meanings of sex within gangs, with a specific focus on the ways in which sex is used to reinforce gang membership and norms, gender roles, and group cohesion. We conducted 58 semi-structured interviews with adolescent members of six gangs. Data were analyzed using thematic content analysis and constant comparative method in MAXQDA. Sexual risk behaviors within gangs are upheld and reinforced through unspoken norms and expectations. These high-risk sexual practices increase group cohesion and reinforce gender norms and power differences. Despite the prevalence of such practices, many gang members felt regret and remorse over their participation but noted it was just part of "the life." Our findings highlight the need for interventions to address the norms of the gang that reinforce sexual risk behavior.

Exposure to community violence and substance use among Black men who have sex with men: examining the role of psychological distress and criminal justice involvement

Young Black MSM (YBMSM) are disproportionately affected by violence, criminal justice involvement, and other structural factors that also increase vulnerability to HIV. This study examined associations between exposure to community violence (ECV) and substance use, psychological distress, and criminal justice involvement (CJI) among YBMSM in Chicago, IL. Respondent driven sampling was used to recruit a sample of 618 YBMSM (aged 16-29) from the South Side of Chicago between June 2013 and July 2014. Weighted logistic regression assessed the direct effects of ECV, CJI, and psychological distress on substance use outcomes. Indirect effects were assessed via path analysis with mean and variance adjusted weighted least squares estimation and sampling weights. Over 90% reported lifetime exposure to violence, 41% had history of CJI, and substance use was common. Almost one-third reported daily or more frequent marijuana use; 17% reported substance use related problems and drug use other than marijuana. ECV was directly and positively associated with CJI, psychological distress, and problematic substance use, with significant indirect effects from ECV to⁠ problematic substance use via CJI and psychological distress. HIV prevention interventions for YBMSM should address the underlying contextual drivers of substance use and psychological distress, including violence exposure and criminal justice involvement.

Mapping the Intersections of Violence on Black Women's Sexual Health within the Jim Crow Geographies of Cincinnati Neighborhoods

Who will revere the Black woman? Who will keep our neighborhoods safe for Black innocent womanhood? Black womanhood is outraged and humiliated. Black womanhood cries for dignity and restitution and salvation. Black womanhood wants and needs protection, and keeping, and holding. Who will assuage her indignation? Who will keep her precious and pure? Who will glorify and proclaim her beautiful image? To whom will she cry rape? Abbey Lincoln, 1970.

Internalizing and externalizing symptoms among Palestinian adolescents from Israel as consequences of their exposure to community violence: Are they moderated by their self-efficacy and collective efficacy?

This article presents the findings of a study that examined the rates and the consequences of exposure to community violence (ECV) as reflected in witnessing and experiencing such violence, among Palestinian adolescents from Israel. In particular, it examined the extent to which these adolescents exhibit high levels of internalizing and externalizing symptoms as consequences of such exposure, and the extent to which self-efficacy and collective efficacy moderate these consequences. A systematic random sample of 760 Palestinian adolescents in Israel (320 boys, and 440 girls) filled out a self-administered questionnaire. The results show that most of the adolescents had witnessed community violence during the last year and during lifetime, and more than one third had directly experienced such violence during their lifetime compared with 19.6% during the last year. Boys were exposed to community violence more often than girls. Moreover, participants' ECV predicted high levels of externalizing and internalizing symptoms. Hierarchical regression analysis revealed that collective efficacy moderated the correlation between experiencing community violence and internalizing symptoms, whereas self-efficacy moderated the correlation between witnessing community violence and externalizing symptoms. There is a need for providing support for youth from close adults as well as from formal and informal resources in the community before and after their ECV.

Exploring masculinities, sexual health and wellbeing across areas of high deprivation in Scotland: The depth of the challenge to improve understandings and practices

Within and across areas of high deprivation, we explored constructions of masculinity in relation to sexual health and wellbeing, in what we believe to be the first UK study to take this approach. Our sample of 116 heterosexual men and women age 18-40 years took part in individual semi-structured interviews (n = 35) and focus group discussions (n = 18), across areas in Scotland. Drawing on a socio-ecological framework, findings revealed experience in places matter, with gender practices rooted in a domestically violent milieu, where localised, socio-cultural influences offered limited opportunities for more egalitarian performances of masculinity. We discuss the depths of the challenge in transforming masculinities in relation to sexual health and wellbeing in such communities.

Exposure to Community Violence and Sexual Behaviors Among African American Youth: Testing Multiple Pathways

African American youth bear a disproportionate burden of sexually transmitted infections. A growing number of studies document that youth exposure to community violence and sexual behaviors are highly correlated. Despite such growing evidence, only a few studies have empirically tested conceptually driven pathways that may account for such relationships. This study seeks to address that gap by exploring multiple pathways linking exposure to community violence and youth sexual behaviors. Using an existing sample of 563 African American youth attending high school, we examined whether possible links between exposure to community violence and sexual activity, sexual risk behaviors were mediated by aggression, low student-teacher connectedness, and negative peer norms. Major findings indicated indirect relationships between exposures to community violence and both sexual activity and risky sex, mediated by aggression and negative peer norms with no significant differences based on gender or socioeconomic status. Overall findings also indicated a significant indirect effect of aggression to risky sex via negative peer norms and from community violence to risky peer norms via aggression. By illuminating ways that community violence, aggression, peer norms, and sexual behaviors are dynamically interrelated, these findings have significant implications for future research and intervention initiatives aimed at addressing the different pathways.

At the intersection of criminal justice involvement and sexual orientation: Dynamic networks and health among a population-based sample of young Black men who have sex with men

Mass incarceration of young Black men has a significant impact on their network composition and stability that, in turn, may have major implications for health and well-being. A sub-group of young Black men with criminal justice involvement (CJI) identify as gay, bisexual or are non-identified men who have sex with men (hereafter MSM). This paper focuses on the potential effects of CJI on the composition of Black MSM social and sexual networks, their stability over time, and concomitant health and social outcomes. We use data from the UConnect study, a population-based cohort of young Black MSM 16-29 years of age (n=618) selected using respondent-driven sampling in Chicago from 2013-2016. Both confidant and sexual network name generators and interpreters were administered at 9-month intervals over three waves of data collection. Ego and dyadic-level data were collected on behaviors prevalent among MSM and including factors associated with network CJI, network stability, and health outcomes. Generalized Structural Equation Models (GSEM) were utilized to determine the relationship between CJI network composition, network stability and behaviors prevalent among young Black MSM and their networks. In the UConnect cohort, 46% had at least once been detained, arrested or spent time in jail or prison. In addition, 20% of participants reported incident CJI over the study period. Respondents with a history of CJI were significantly more likely to have CJI homophily in their confidant and sexual networks. Multivariate analyses demonstrate that the association between one's history of CJI, housing instability and drug use is partially explained by one's network CJI. In addition, a higher prevalence of network CJI is associated with increased turnover in the confidant network, and this network instability is also related to important health and social outcomes. This analysis describes the networks of criminal justice involved men among a representative sample of young Black MSM and demonstrates the relationship between CJI network homophily, network stability and their impact on several key health and social outcomes relevant to this population.

Neighborhood context, psychological outlook, and risk behaviors among urban African American youth

OBJECTIVES

Researchers have found a link between neighborhood risk factors and youth risk behaviors. However, the pathways by which this occurs remain poorly understood. This study sought to test a hypothesized pathway that suggests the influence of neighborhood risk on sexual risk and substance use among urban African American youth may operate indirectly via their psychological outlook about current and future opportunities.

METHOD

Secondary data analysis using structural equation modeling (SEM) was used to test the conceptual framework. The sample included 592 African American youth (61% female, 39% male) mean age 15.58 years, 1.23 SD. A modified structural equation model (SEM) met prespecified global fit index criteria.

RESULTS

The model contained 3 indirect paths linking increased neighborhood risk to increased sexual risk and substance use through higher levels of negative psychological outlook and youth approval of substance use.

CONCLUSIONS

These findings increase our understanding of factors that influence the initiation and progression of substance use and sexual risk behaviors among urban African American adolescents. (PsycINFO Database Record

Mediators of the Relation Between Community Violence and Sexual Risk Behavior Among Adults Attending a Public Sexually Transmitted Infection Clinic

Prior research shows that violence is associated with sexual risk behavior, but little is known about the relation between community violence (i.e., violence that is witnessed or experienced in one's neighborhood) and sexual risk behavior. To better understand contextual influences on HIV risk behavior, we asked 508 adult patients attending a publicly funded STI clinic in the U.S. (54 % male, M age = 27.93, 68 % African American) who were participating in a larger trial to complete a survey assessing exposure to community violence, sexual risk behavior, and potential mediators of the community violence-sexual risk behavior relation (i.e., mental health, substance use, and experiencing intimate partner violence). A separate sample of participants from the same trial completed measures of sexual behavior norms, which were aggregated to create measures of census tract sexual behavior norms. Data analyses controlling for socioeconomic status revealed that higher levels of community violence were associated with more sexual partners for men and with more episodes of unprotected sex with non-steady partners for women. For both men and women, substance use and mental health mediated the community violence-sexual risk behavior relation; in addition, for men only, experiencing intimate partner violence also mediated this relation. These results confirm that, for individuals living in communities with high levels of violence, sexual risk reduction interventions need to address intimate partner violence, substance use, and mental health to be optimally effective.

Addressing Unmet Sexual Health Needs among Black Adolescents with Mental Illnesses

Despite advances in HIV epidemiologic and prevention research, adolescents with mental illnesses remain a historically underserved group with respect to human immunodeficiency virus (HIV)/sexually transmitted infection (STI) prevention resources. Black adolescents with mental illnesses in particular are a relatively underserved, hidden population in the field of sexual health. Strategies and guidelines are needed to account for underlying psychopathology among Black adolescents with mental illnesses in ways that current models have yet to address. In this paper, we propose several actionable mechanisms to better integrate HIV/STI and mental health related services and activities for sexual health promotion.

Aggressive and violent behaviors in the school environment among a nationally representative sample of adolescent youth

BACKGROUND

The purpose of this study was to describe the prevalence of aggressive and violent behaviors in the context of the school environment in a nationally representative sample of adolescent youth and to illustrate these patterns during 2001-2011.

METHODS

We analyzed data from 84,734 participants via the Youth Risk Behavior Surveillance System (YRBSS). Frequencies were visualized using heatmaps. One-way analyses of variance and corresponding post hoc tests helped to identify if differences in prevalence fluctuated significantly across all years.

RESULTS

Rates of youth feeling unsafe in their school environment, bringing weapons to school, and engaging in physical fighting on school property continue to persist. Findings illustrated that Hispanic youth and youth classified as "other" have emerged as particularly high-risk demographic subgroups over the past decade. Peer victimization and sexual victimization continue to affect girls disproportionately.

CONCLUSIONS

Though some variation within demographic subgroups exists, rates of aggressive and violent behaviors in the context of the school environment continue to persist. Implications for the coordinated prevention of aggressive and violent behaviors among adolescent youth are discussed and recommendations for school-based prevention efforts are identified.