Exploring the social and community context of African American adolescents' HIV vulnerability

Youth Empowered Advocating for Health (YEAH): Facilitating Partnerships Between Prevention Scientists and Black Youth to Promote Health Equity

Structural racism inflicts a disproportionate burden of stress and trauma within Black communities, resulting in physical and mental health inequities that impact Black youth. Yet few multilevel interventions exist to address these deeply rooted inequities from a preventive standpoint, and even fewer are informed by the participatory input of the impacted communities. To bridge these gaps, we developed a community-based prevention strategy that promotes agency and active resistance to structural racism, Youth Empowered Advocating for Health (YEAH), and implemented it across various settings. We outline the development, implementation, and expansion of YEAH as a tool for promoting optimal health among Black communities. Lastly, we discuss lessons learned and offer a framework outlining key principles for prevention scientists to partner with Black youth and engage them in translational science to address structural racism. This framework is aimed at driving policies, practices, and procedures that promote equitable and sustainable change for and with Black communities.

Using intergenerational photovoice to understand family strengths among Native American children and their caregivers

The purpose of the current study was to examine Native American children and caregivers' perspectives of family and cultural strengths using photovoice and to identify lessons learned from the first-ever implementation of intergenerational photovoice with Native Americans. Participants were Native American, low-income caregivers (n = 6) and their children (n = 12) between the ages of 10 and 15 who participated in six photovoice sessions. The themes that emerged from photos and group discussion included myriad challenges faced by Native American families including exposure to community violence, substance abuse, and criminal offending and incarceration. Themes also emerged that highlighted the strengths of Native families that were used to overcome identified challenges, including religion/spirituality, engagement in traditional cultural practices (e.g., prayer, song, dance), healthy activities (e.g., running, meditation). These data provided foundational information that is currently being used, along with other data, to develop a culturally grounded, strengths-focused, family-based program (Tiwahe Wicagwicayapi [Strengthening/Growing Families in Lakota]) to prevent adverse childhood experiences. We also discuss the challenges of intergenerational photovoice and lessons learned to inform future intergenerational photovoice projects.

The Impact of COVID-19 Among Black Girls: A Social-Ecological Perspective

Objective

To explore the impact of the COVID-19 pandemic on Black adolescent girls’ physical, psychological, and sexual development.

Methods

Semistructured interviews were conducted with 25 girls (9–18 years old) primarily across the Midwestern United States. Interviews were conducted until theoretical saturation was reached. We conducted a conventional content analysis by reviewing transcripts, coding data, and developing themes.

Results

Utilizing the social-ecological model findings revealed themes related to the individual-, interpersonal-, institutional-, and community-level changes that Black girls experienced during the COVID-19 pandemic.

Conclusions

Black adolescent girls need opportunities to discuss the changes, receive relevant resources, and have spaces to support their physical, psychological, and sexual development. Systems such as families, schools, and clinics should implement programming to facilitate discussions around the impact of COVID-19 on Black girls.

Using photovoice to understand and amplify youth voices to prevent sexual and relationship violence

AIMS

Efforts to improve prevention of sexual and relationship violence (SRV) among adolescents call for more centering of youth voices, experiences, and skills to design prevention programs that incorporate youth engagement rather than those that are designed by adults for youth. Amplifying the voices of historically marginalized youth are especially needed. Photovoice (PV) is a participatory action method that can empower youth and generate prevention knowledge.

METHODS

The current project used PV to engage youth in late middle and early high school to discuss how they could work to prevent SRV in their community. A convenience sample of nine youth (predominately Native American) participated over seven sessions.

RESULTS

A key theme they generated is that SRV prevention needs to be viewed as relational. Participants described the complexity of prevention, including how youth need social support to thrive and prevent SRV and that asking for help can be challenging. Results also highlighted that youth can provide help and support, but it is not always welcome in addition to underscoring that youth are resilient and can be prevention leaders.

CONCLUSION

Innovations in SRV prevention, especially for older adolescents, should work to engage youth as prevention partners. Participatory research methods like photovoice can be an important part of that process.

"Youth Photovoice": Promoting Youth-Driven Community Changes for HIV Prevention in Rural Malawi

ABSTRACT

To meet the Joint United Nations Programme on HIV/AIDS global goal of no new HIV infections by 2030, it is imperative to reduce new infections among youth. Youth Photovoice was a 10-month, participatory, community-action research project developed to engage rural Malawi youth in an HIV prevention project focused on community-level outcomes. In this study, we describe how participants in Youth Photovoice engaged adults and community leaders to implement action plans, as well as the community and individual changes that occurred as a result of these collaborative efforts. Youth Photovoice participants, their parents, and local leaders in the community participated in focus groups and individual interviews. Community-level changes, such as moving initiation ceremonies to churches and changes to local business practices, were observed, along with increased community and parental involvement in youth monitoring for local events and activities. This youth-led project led to changes in the community environment that reduced exposure to situations supporting unsafe sex, uncovered ways that youth can lead collaborations with adults, and informed the implementation of plans for community action.

Developing Action Plans in Youth Photovoice to Address Community-Level HIV Risk in Rural Malawi

Youth-driven approaches to HIV prevention can engage youth and improve health outcomes. Photovoice has been used to engage youth in identifying the assets and challenges in their communities. In sub-Saharan Africa, youth remain vulnerable to HIV infection. This article describes a photovoice project, named Youth Photovoice, conducted in rural Malawi, which focused on community places and situations relating to risky sexual behaviors that place youth at risk of HIV infection. Twenty-four youth, ages 13-17 (12 males and 12 females), participated in Youth Photovoice. During the photovoice process, youth identified five community situations and places that put them at risk of unsafe sex and thus HIV infection: initiation ceremonies, isolated places, community celebrations, local businesses such as bars and rest houses, and church-sponsored activities. Youth used a systematic action planning process to develop action plans. They presented their action plans to local leaders and parents. Parents and leaders responded positively and agreed to help the youth carry out their plans. If their plans to address community situations that put them at risk of unsafe sex succeed, there will be a direct impact on reducing the risk of HIV infection among youth. Youth Photovoice provided the opportunity for youth to obtain new skills, build new partnerships, and present their ideas to community leaders. Integrating this action planning process into photovoice helped to guide the youth toward actualizing their HIV prevention plans in their community. This process can increase the effectiveness of photovoice initiatives to address other community issues in a wide variety of settings.

"What I wish my doctor knew about my life": Using photovoice with immigrant Latino adolescents to explore barriers to healthcare

BACKGROUND

Latinos in the USA have reported more frequent discriminatory treatment in healthcare settings when compared to their White counterparts. In particular, foreign-born Latinos report discrimination more than Latinos born in the USA. Such patient-reported racial/ethnic discrimination appears to contribute to specific health consequences, including treatment seeking delays, interruptions in care, and medical mistrust. Immigrant Latino adolescents in the USA experience a variety of health disparities, yet little is known about their views of the healthcare experience, their perceptions of discriminatory treatment, or ways in which they would like their relationships with healthcare providers to be different.

METHODS

This work, based in a larger interdisciplinary social work-led initiative, used photovoice with two groups of immigrant Latino adolescents to explore the topic "what I wish the doctor knew about my life." The findings were used to engage healthcare stakeholders as part of a pilot intervention aimed at decreasing provider bias toward immigrant Latino youth.

RESULTS/DISCUSSION

Findings illuminated ways that the immigrant experience affects the lives and health of Latino adolescents in North Carolina. To improve their health, it is critical to understand, from their perspectives, the ways their lives can be complicated by experiences of migration, stereotypes, and cross-cultural communication challenges and how their interactions with authority figures in one sector, such as education, influence interactions in health care. Understanding the healthcare barriers faced by immigrant Latino youth is critical to any effort to improve the system of care for immigrant Latino populations.

Collaborating With Youth in School Health Promotion Initiatives With Photovoice

Photovoice, a community-based approach that is being embraced in school settings, can help to nurture collaborations with youth, particularly adolescents, and engage them in the development of social policy and health promotion projects. Photovoice is an approach that positions school nurses to inspire youth to take ownership of health promotion issues that directly affect them in the school and in their communities. Engaging youth in Photovoice not only allows advocates to directly work with youth but also promotes critical thinking and the exploration of topics that may not otherwise be considered. Photovoice raises awareness about issues through critical dialogue and is well suited to engage youth and provide a channel for youth to assert their voices.

Body Mapping as a Youth Sexual Health Intervention and Data Collection Tool

In this article, we describe and evaluate body mapping as (a) an arts-based activity within Fostering Open eXpression Among Youth (FOXY), an educational intervention targeting Northwest Territories (NWT) youth, and (b) a research data collection tool. Data included individual interviews with 41 female participants (aged 13-17 years) who attended FOXY body mapping workshops in six communities in 2013, field notes taken by the researcher during the workshops and interviews, and written reflections from seven FOXY facilitators on the body mapping process (from 2013 to 2016). Thematic analysis explored the utility of body mapping using a developmental evaluation methodology. The results show body mapping is an intervention tool that supports and encourages participant self-reflection, introspection, personal connectedness, and processing difficult emotions. Body mapping is also a data collection catalyst that enables trust and youth voice in research, reduces verbal communication barriers, and facilitates the collection of rich data regarding personal experiences.

Exchange of Sex for Drugs or Money in Adolescents and Young Adults: An Examination of Sociodemographic Factors, HIV-Related Risk, and Community Context

The goal of this research was to examine associations among sociodemographic factors, HIV risk, and community context (e.g., economic insecurity, job training, housing instability, crime victimization, and perceived community norms) in adolescents and young adults who ever exchanged sex for drugs or money. Anonymous survey data were collected using ACASIs at community venues where adolescents and young adults congregate in resource-challenged, STI prevalent, urban, US neighborhoods. Conventional descriptive statistics, Fisher's exact tests, and generalized estimating equations approaches were used to examine associations. Participants (1818, 95.5 % of those screened eligible) were, on average, aged 21.0 years; 42.2 % were males, and 4.6 % were transgender. Almost one-third (32.1 %) identified as gay or lesbian, 18.1 % identified as bisexual; 66.2 % were Black and 21.0 % were Hispanic; 1.3 % was 'living on the street'. A sizeable proportion reported HIV-related risk: 16.3 % exchanged sex, 12.6 % had sex with someone they knew to be HIV-infected, 7.8 % had sex with someone who injected drugs, and 1.3 % injected drugs. Multivariate comparisons identified a number of variables (e.g., being male or transgender, homelessness, sex with a partner who has HIV, STI history, unemployment, job training access, housing instability, crime victimization, perceived community norms) that were significantly associated with exchange of sex (p < 0.05). This research contributes to the knowledge-base regarding exchange of sex among adolescents and young adults, particularly as it relates to community context. Longitudinal studies to describe the trajectory of social, health, and physical risks and consequences are needed for development of effective evidence-based prevention strategies.

Does Parental Monitoring Moderate the Impact of Community Violence Exposure on Probation Youth's Substance Use and Sexual Risk Behavior?

The present study examined whether parental monitoring buffers the negative effects of communtity violence exposure on probation youth's substance use and sexual risk behaviors. Among a sample of 347 Chicago youth on probation, ages 13-17 years, parental monitoring did not moderate the relationship between community violence exposure and probation youth's sexual risk and substance use. However, parental monitoring was independently associated with less engagement in sexual risk and substance use, and community violence exposure was independently associated with more risk behavior among probation youth. The present study contributes to the growing literature on the impact of community violence exposure and parenting on adjudicated youth risk.

Efficacy of the Young Women's CoOp: An HIV Risk-Reduction Intervention for Substance-Using African-American Female Adolescents in the South

HIV/sexually transmitted infection (STI) risk-reduction interventions are needed to address the complex risk behaviors among African-American female adolescents in disadvantaged communities in North Carolina. In a two-group randomized trial, we reached 237 sexually active, substance-using African-American female adolescents, to test a risk-reduction intervention, the Young Women's CoOp (YWC), relative to a nutrition control. In efficacy analyses adjusting for baseline condom use, at three-month follow-up participants in the YWC were significantly less likely to report sex without a condom at last sex relative to control. There were mixed findings for within-group differences over follow-up, underscoring the challenges for intervening with substance-using female youths.

Future Directions in Research on Racism-Related Stress and Racial-Ethnic Protective Factors for Black Youth

Research on racism-related stress and racial-ethnic protective factors represents an important enterprise for optimizing the mental health of African American and other racial and ethnic minority youth. However, there has been a relative dearth of work on these factors in the clinical psychology research literature, and more work is needed in outlets such as these. To this end, the current article adopts a developmental psychopathology framework and uses recent empirical findings to outline our current understanding of racism-related stress and racial-ethnic protective factors (i.e., racial identity, racial socialization, Africentric worldview) for African American youth. We then provide nine recommendations-across basic, applied, and broader/cross-cutting research lines-that we prioritize as essential to advancing the future scientific investigation of this crucial research agenda. Within and across these recommendations, we issue a charge to researchers and clinicians alike, with the ultimate goal of alleviating the negative mental health impact that racism-related stress can have on the well-being and mental health of African American and other racial and ethnic minority youth.

Ensuring youth's right to participation and promotion of youth leadership in the development of sexual and reproductive health policies and programs

The purpose of this article was to reflect on the concepts of adolescence and youth, summarize models and frameworks developed to conceptualize youth participation, and assess research that has attempted to evaluate the implementation and impact of youth participation in the field of sexual and reproductive health and rights (SRHR). We searched and critically reviewed relevant published reports and "gray literature" from the period 2000-2013. "Young people" are commonly defined as those between the ages of 10 and 24 years, but what it means to be a young person varies largely across cultures and depends on a range of socioeconomic factors. Several conceptual frameworks have been developed to better understand youth participation, and some frameworks are designed to monitor youth development programs that have youth participation as a key component. Although none of them are SRHR specific, they have the potential to be adapted and applied also for adolescents' SRHR programs. The most monitored and evaluated intervention type is peer education programs, but the effectiveness of the approach is questioned. There are few attempts to systematically evaluate youth participation, and clear indicators and better methodologies still need to be developed. More research and documentation as well as the adoption of innovative practices for involving youth in sexual and reproductive health programs are needed. Participation is a right and should not only be evaluated in terms of effectiveness and impact. Youth participation in program and policy development should still be a priority.

Where is the faith? Using a CBPR approach to propose adaptations to an evidence-based HIV prevention intervention for adolescents in African American faith settings

African American adolescents are at increased risk for HIV/AIDS. Using a community-based participatory research approach, we engaged three black churches in adapting an evidence-based HIV prevention intervention, Focus on Youth (FOY)+ImPACT, for faith settings. To identify potential adaptations to increase FOY's relevance, utility, and efficacy for faith settings, we conducted eight focus groups pre- and post-intervention. Recommendations for maintaining FOY's core elements and enhancing its cultural authenticity include the following: incorporating faith tools, building pastor capacity, strengthening parent-child communication skills, and expanding social support for parents and youth. Engaging faith communities in adapting and implementing evidence-based HIV prevention programs could reduce HIV/AIDS disparities.