Attitudes and beliefs toward biobehavioural research participation: voices and concerns of urban adolescent females receiving outpatient mental health treatment

Are Adolescents Sensitive About Sensitive Data? Exploring Student Concerns About Privacy, Confidentiality, and Data Use in Health Research

PURPOSE

We quantitively explored adolescents' concerns about privacy, confidentiality, and data use in health research and their potential impact on the accuracy of self-report data.

METHODS

We analyzed data from 17,729 secondary school students who participated in the 2023 OxWell Student Survey. The survey assessed 5 concerns about privacy, confidentiality, and data use and asked students whether these concerns impacted the accuracy of their answers. We calculated the proportions who (a) endorsed each concern and (b) reported inaccuracies associated with their concern(s). We then examined associations of concerns and self-reported inaccuracies with nonresponse and score distributions on sensitive measures of mental illness (depression/anxiety and disordered eating) and adversity (child maltreatment) using logistic regression.

RESULTS

46.0% (8,160/17,729) of students endorsed ≥1 concern, and of these, 29.2% (2,379/8,160) reported associated inaccuracies. Relative to boys, concerns were more common amongst gender diverse adolescents (adjusted odds ratio [aOR] = 5.71, 95% confidence interval [CI] 4.40-7.48), gender nondisclosing adolescents (aOR = 4.36, 95% CI 3.62-5.26), and girls (aOR = 2.52, 95% CI 2.36-2.69), with smaller differences in self-reported inaccuracies. Students with self-reported inaccuracies were significantly more likely to have nonresponse on the 3 measures of mental illness and adversity (aORs = 1.53-3.38), whilst score distributions on those measures varied substantially according to whether students reported concerns.

DISCUSSION

Concerns about privacy, confidentiality, and data use were common amongst student participants, as were self-reported inaccuracies. Substantial differences in nonresponse and score distributions on sensitive measures highlight potential impacts of these concerns. Co-designing and implementing strategies to address these concerns might help to support evidence-based decision-making by improving representativeness and data quality in adolescent health research.

Informed consent, genomic research and mental health: A integrative review

BACKGROUND

Research on genomics has increased while the biobank activities are becoming more common in different countries. In the mental health field, the questions concerning the potential participants' vulnerability as well as capacity to give the informed consent can cause reluctancy in recruiting persons with mental health problems, although the knowledge and understanding of mental health problems has remarkable changed, and practice is guided with inclusive approaches, such as recovery approach.

AIM

The aim of this study was to describe the current knowledge of informed consent practices in the context of genomic research on mental health from the nurses' viewpoint.

METHODS

An integrative review was conducted with search from seven international databases. Data consist 14 publications which were analyzed with thematic analysis.

ETHICAL CONSIDERATIONS

Ethical requirements were respected in every phase of the research process.

FINDINGS

Most of the papers were published in USA and between 2000-2010. Eight reports were categorized as discussion papers, four qualitative studies and one quantitative study. The thematic analysis provided information on five themes: complexity with the capacity to consent, mixed emotions towards participation, factors influencing the decision to participate, nurses' informed consent process competence and variations between consent procedures.

DISCUSSION

In the informed consent practices, there are various aspects which may affect both the willingness to participate in the study and the informed consent process itself. Implications for practice, education, research, and policies are discussed.

CONCLUSION

There is a need for more updated international research on the topic in the context of different international and national guidelines, legislation, and directives. This study provided a viewpoint to the more collaborative research activities with people with lived experiences also in this field of research following the ideas of recovery approach.

Best practices for recruitment of adolescents for biobanking and precision health research: a retrospective analysis comparing juvenile idiopathic arthritis cases with healthy controls

BACKGROUND

Precision health in adolescents relies on the successful collection of data and biospecimens from an adequately sized sample of cases and comparison group(s), often healthy controls, to answer the research question. This research report describes the recruitment strategy, enrollment rates, and approach utilized in a successful biobehavioral research study. The study was designed to examine key health indicators in adolescents (13-17 years of age) with juvenile idiopathic arthritis (JIA) compared to a control group of healthy adolescents. The purpose of this analysis is to establish best practices and identify strategies to overcome barriers to recruitment of older adolescents, an age group that tends to be underrepresented in research studies.

METHODS

A retrospective secondary analysis of data from a parent study about JIA with high consent rates was employed to explore factors affecting enrollment into the biobehavioral study.

RESULTS

Of the 113 subjects who were recruited to the study, 74 met the eligibility criteria and reviewed the consent form. The consented group (n=40) represents 54% of those who were eligible upon initial screening. The rate of project enrollment was 2.7 participants per month. The pediatric rheumatologists referred 85% of the JIA group, and the study's principal investigator, a nurse scientist, referred 95% of the control group. Typical recruitment strategies, such as posting on social media, distributing flyers, and cold-calling potential participants from the clinic schedule were ineffective for both cases and controls. Barriers to enrollment included scheduling and fear of venipuncture. There were no demographic characteristics that significantly explained enrollment, differentiating between those who agreed to participate compared to those who refused. Successful strategies for enrollment of adolescents into this biobehavioral research study included scheduling study visits on weekends and school holidays; an informed consent and assent process that addressed adolescent fears of venipuncture; including a JIA patient on the study team; and utilizing existing relationships to maximize enrollment efforts.

CONCLUSIONS

Effective recruitment and enrollment practices were relationship-specific and patient-centered. Researchers should utilize best practices to ensure that precision health for adolescents is advanced.

Understanding Neighborhoods' Impact on Youth Substance Use and Mental Health Outcomes in Paterson, New Jersey: Protocol for a Community-Based Participatory Research Study

BACKGROUND

Substance use among youth is a major public health concern. Of note, substance use among youth is increasing in prevalence, and the incidence of substance use at earlier ages is rising. Given the long-term consequences of early substance use, it is important to identify factors that increase youth vulnerability to drug use, as they may be important targets for future interventions.

OBJECTIVE

This study aims to use innovative methods, such as venue-based sampling, to recruit youth who are disconnected from school and use community-based participatory research to gain a better understanding of the prevalence of substance use and important correlates among youth aged between 13 and 21 years in Paterson, New Jersey, a low-income, urban community. The study will use a convergent, mixed methods design involving multiple data collection components and the analysis of a ministrative data source, designed with the strengths of complex intervention frameworks in mind. The overall aims of the study are to identify the prevalence of substance use among youth who are engaged in school and not engaged in school; to understand important antecedents and correlates of substance use; and to use this information to inform social, environmental, and culturally appropriate interventions to address substance use and its correlates among youths in a lower-resourced urban community.

METHODS

This study will use both qualitative and quantitative methods to address important questions. Specifically, semistructured interviews using focus group and interview methodologies will be used to assess youths' lived experiences and will account for specific details that quantitative methods may not be able to attain. In addition, quantitative methods will be used to examine direct and multilevel associations between neighborhood factors and youth substance use and mental health outcomes.

RESULTS

A previous analysis from a substance use initiative in Paterson, New Jersey found that youth who use substances such as marijuana and alcohol are more likely to have higher rates of depression and anxiety. On the basis of the research questions, this study will examine the association between neighborhood characteristics, substance use, and mental health symptoms among youth in Paterson by using quantitative and qualitative methods and will use these findings to inform the adaptation of a community- and evidence-based substance use prevention intervention for these youths.

CONCLUSIONS

The findings of this study will provide an important contribution to understanding the role of socioecological factors in predicting substance use and mental health outcomes among youth in a lower-resourced, urban community. Furthermore, these findings will serve as evidence for the development of a culturally informed, community-based prevention program to address substance use disparities for youth, including those who are truant in Paterson, New Jersey.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/29427.

A multilevel mHealth drug abuse and STI/HIV preventive intervention for clinic settings in the United States: A feasibility and acceptability study

BACKGROUND

Drug abuse and sexually transmitted infections (STIs), including the human immunodeficiency virus (HIV), remain significant public health concerns in the United States. Youth are at disproportionate risk of drug use and STIs/HIV, yet interventions aimed at improving STI and HIV testing and reducing STI/HIV risk behaviors through technology-based engagement in clinic settings are limited. The purpose of this study was to examine the feasibility and acceptability of Storytelling 4 Empowerment (S4E), a multilevel mobile-health drug abuse and STI/HIV preventive application (app) for clinic settings. We also explored uptake of STI/HIV testing among youth immediately post-intervention.

METHOD

Employing community-based participatory research principles and a multi-method research design, we developed a clinician-facing app, and examined the feasibility and acceptability of S4E among clinicians (n = 6) and youth (n = 20) in an urban youth-centered community health clinic. S4E aimed to improve clinician-youth risk communication and youths' drug use and STI/HIV knowledge, self-efficacy, and refusal skills. We also explored youths' uptake of STI and HIV testing. Quantitative data were analyzed by computing mean scores and proportions, and qualitative analyses followed the tenets of content analysis.

RESULTS

Among eligible participants, 86.9% of youth and 85.7% of clinicians enrolled in the study, suggesting the feasibility of recruiting participants from the targeted clinic. Most clinicians identified as non-Hispanic white (83%) and female (66.7%). Among the youth, 70% identified as non-Hispanic white, followed by 30% African American, and 50% identified as female with a mean age of 19.6 (SD = 1.5, Range = 16-21). The quantitative findings suggest that the acceptability of S4E is high, as indicated by the Client Satisfaction Questionnaire (mean score = 25.2, SD: 4.8). Immediately post-intervention, all youth who reported past 90-day condomless sex or having never been tested for STIs or HIV in their lifetime, were tested for both STIs and HIV. Qualitative themes revealed four overarching themes, including S4E: (1) faciliated timely, targeted, and tailored prevention and risk reduction strategies; (2) shaped clinician and youth communication and interaction during the clinic visit; (3) may have improved uptake of STI/HIV testing and increased STI/HIV knowledge and self-efficacy; and (4) had high feasibiliy and acceptability among youth and clninicans.

CONCLUSIONS

Findings suggest the feasibility and acceptability of S4E in an urban community-based health clinic setting. A next important step is to examine the efficacy of S4E in a randomized controlled trial design.

Improving recruitment and retention of adolescents and young adults with cancer in randomized controlled clinical trials

Participation of adolescents and young adults (AYAs) with cancer in randomized clinical trials (RCTs) is necessary to advance treatments and psychosocial programs. Exploring AYAs experiences in an RCT will inform strategies to support recruitment and retention. A qualitative design was used to study the experiences of 13 AYAs in the Stories and Music for Adolescent and Young Adult Resilience during Transplant I (SMART I) trial. Key themes included: Weighing the Pros and Cons; Randomization Preferences; Completing Measures; and Worthwhile Experience. The experiences of AYAs during RCTs can bring insights that inform the design and management of AYA trials. Strategies include improving assent/consent processes, design of electronic interfaces and encouraging researcher flexibility.

Physical Activity Interventions to Decrease Substance Use in Youth: A Review of the Literature

BACKGROUND

Adolescent substance use, a major problem in the United States, has a significant negative effect on both short- and long-term mental and physical health. Physical activity (PA) may offer potentially effective strategies to combat substance use in youth. Like substance use, PA behaviors developed during adolescence persist into adulthood, so adolescence may be an ideal period in which to implement PA interventions to prevent substance abuse. However, there are no known systematic literature reviews of PA-based interventions that target substance use in adolescence.

OBJECTIVES

To review PA interventions for adolescents, including research designs, intervention characteristics, and measures of substance use.

METHODS

Five databases were searched for articles published in English peer-reviewed journals. Search terms were related to the adolescent population, substance use, and PA interventions.

RESULTS

17 articles fit inclusion criteria. The results suggest that PA interventions may decrease substance use in teens. A majority of the interventions were delivered in high schools. Substance use measures/outcomes included intention or willingness to use, cessation, and actual use. Alcohol use was measured most, followed by marijuana and tobacco use. Although most of the studies utilized group sessions to deliver interventions, decreased substance use was also associated with one-time, multi-health consultations. Conclusions/Importance: School-based interventions targeting multiple health behaviors may offer a particularly effective and efficient way to decrease substance use in adolescents.

The Acceptability of Biobehavioral Research With Latino Youth in the United States

In this study, we explored Latinx adolescents’ knowledge and perceptions of biobehavioral research and their willingness to participate in such studies. We conducted four focus groups in the summer of 2014 with Latinx adolescents in Texas between the ages of 12 and 17 years ( n = 17; 53% male; M age = 14.6 years [ SD = 1.66]) who were recruited from a community-based clinic. Five themes emerged from our content analysis: (a) protection of human subjects is important to participants, (b) comfort with providing different types of biological data varies depending on different factors, (c) engagement in biobehavioral research should be grounded in a cultural lens, (d) providing bilingual research staff is essential, and (e) adolescents have various motivations for participating. Findings highlighted how various factors could serve as both barriers and facilitators to participation. Our study provides insight into strategies for conducting biobehavioral research with Latinxs, who are the fastest growing group of adolescents in the United States and experience disparities in health-risk behaviors that can be better understood through research approaches that integrate biological and psychological measures. Without considering the perspectives of historically marginalized or understudied populations, we jeopardize the quality and validity of research findings, and risk harming participants.

Sexual health research among youth representing minority populations: To waive or not to waive parental consent

Human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs) significantly burden youth aged 13-24 years in the United States. Directly engaging youth in sexual health research is a public health priority and urgently needed to develop targeted, youth-friendly, and culturally relevant HIV/STI prevention interventions. Controversies arise, however, regarding informed assent and consent, parental permission or consent, and the definition of "child"/"minor" as it relates to medical, legal and ethical issues. In this paper, we describe challenges in the human subjects review processes that were undertaken before beginning an HIV/STI prevention research project with sexually active youth in an urban setting. These findings provide important contextual information to facilitate youth sexual health research and care, and Institutional Review Board approval processes with fewer delays.

Antiretroviral Therapy Adherence Enhancing Interventions for Adolescents and Young Adults 13-24 Years of Age: A Review of the Evidence Base

INTRODUCTION

Youth living with HIV are highly under-represented in the evidence base for adherence interventions, despite their diverse and unique needs and barriers.

OBJECTIVE

This systematic review aimed to identify antiretroviral therapy (ART) adherence interventions specifically targeting adolescents and young adults (defined as ages 13-24) with the goal of characterizing the evidence base.

METHODS

Articles were identified using the PubMed database and cover work published through September 14, 2015.

INCLUSION CRITERIA

(1) average age 13 to 24, (2) HIV positive, (3) on or beginning ART, (4) intervention targeted ART adherence in full or in part, (5) reported adherence, viral load, and/or CD4 count outcomes. Strength of evidence was defined as level 1 [randomized controlled trial (RCT) with significance testing on outcomes], 2 (within group studies with statistical testing on outcomes), 3 (RCTs with descriptive results), or 4 (within group studies with descriptive results).

RESULTS

Of 151 articles, 10 met inclusion criteria. Published between 2003 and 2014, these studies evaluated diverse intervention approaches. Most were conducted in the US and were small pilots that have yet to be replicated despite promising results. Only 3 studies met criteria for highest level strength of evidence; 2 supported a phone-based counseling approach with adherence monitors and 1 for weekly individual and family counseling.

CONCLUSIONS

Despite nearly 20 years passing since the wide-scale availability of ART, and clear recognition that adolescents and youth adults fair worse on the cascade of HIV care, the evidence base remains sparse and underdeveloped. Promising approaches need replication and more rigorous studies are desperately needed.

Understanding Ethical Issues of Research Participation From the Perspective of Participating Children and Adolescents: A Systematic Review

BACKGROUND

The past 20 years have seen distinct shifts in the way the participation of children and adolescents in research is viewed. This has been emphasized by the growing pediatric research enterprise. Additional information on children's and adolescents' experiences during research participation is needed to better inform researchers on the ethical conduct of research with this vulnerable population.

AIMS

The objective of this analysis was to examine ethical issues in research with children and adolescents from their perspective as participants, including: assent, parental consent, risk perception, impact of research participation, and incentives.

METHODS

This systematic review was conducted per the Long, Godfrey, Randall, Brettle, and Grant framework by means of an iterative searching process. Using the key words "research ethics" and "child or pediatric or adolescent," PubMed, CINAHL, and EBSCOhost databases were searched to identify articles. Limitations placed on the searches were: English language, year of publication between 2003 and 2014, humans, abstract available, and age birth-18 years.

FINDINGS

Twenty-three empiric studies were identified and formed the sample. Included studies represented a diverse range of areas of research, methods, settings, sample demographics, authors, and journals.

LINKING EVIDENCE TO ACTION

Even young children demonstrated the ability to understand essential elements of research, although there is variability in children's level of understanding. Trust was a significant contributing factor to children's and adolescents' participation in research, and also shaped their assessments of risk. Research participation was mainly beneficial for children and adolescents. Incentives were mainly viewed positively, although concerns of possible undue influence were expressed.

Principal components analysis to identify influences on research communication and engagement during an environmental disaster

OBJECTIVES

To discern community attitudes towards research engagement in Libby, Montana, the only Superfund site for which a public health emergency has been declared.

STUDY DESIGN

Survey study of convenience samples of residents near the Libby, Montana Superfund site.

PARTICIPANTS

Residents of the Libby, Montana area were recruited from a local retail establishment (N=120, survey 1) or a community event (N=127, survey 2).

MEASURES

Two surveys were developed in consultation with a Community Advisory Panel.

RESULTS

Principal components of survey 1 showed four dimensions of community members' attitudes towards research engagement: (1) researcher communication and contributions to the community, (2) identity and affiliation of the researchers requesting participation, (3) potential personal barriers, including data confidentiality, painful or invasive procedures and effects on health insurance and (4) research benefits for the community, oneself or family. The score on the first factor was positively related to desire to participate in research (r=0.31, p=0.01). Scores on factors 2 and 3 were higher for those with diagnosis of asbestos-related disease (ARD) in the family (Cohen's d=0.41, 0.57). Survey 2 also found more positive attitudes towards research when a family member had ARD (Cohen's d=0.48).

CONCLUSIONS

Principal components analysis shows different dimensions of attitudes towards research engagement. The different dimensions are related to community members' desire to be invited to participate in research, awareness of past research in the community and having been screened or diagnosed with a health condition related to the Superfund contaminant.

A Web 2.0 and Epidemiology Mash-Up: Using Respondent-Driven Sampling in Combination with Social Network Site Recruitment to Reach Young Transwomen

Respondent-driven sampling (RDS) peer referral has been proven to be an effective recruitment method for hard-to-reach populations; however, its application in diverse populations is limited. Recruitment occurred in two phases: RDS-only followed by development and implementation of an online social network strategy in combination with RDS peer referral (RDS + SNS). Compared to RDS-only, RDS + SNS reached a sample that was younger (χ(2) = 9.19, P = .03), more likely to identify with a non-binary gender identity (χ(2) = 10.4247, P = .03), with less housing instability (50.5 vs. 68.6 %, χ(2) = 9.0038, P = .002) and less sex work (19.7 vs. 31.4 %, χ(2) = 5.0798, P = .02). Additionally, we describe lessons learned as a result of implementing our online social network strategy. Our findings underscore the importance of integrating Internet-driven strategies to meet challenges in sample diversity and recruitment of young transwomen.

Buddy Study: Partners for better health in adolescents with type 2 diabetes

AIM: To investigate whether assigning young, healthy and motivated lay volunteer partners (“buddies”) to adolescents with type 2 diabetes improves hemoglobin A1c (HbA1c).

METHODS: Adolescents with type 2 diabetes were randomized to partnering with a “buddy” or to conventional treatment. During the initial screening visit, which coincided with a routine outpatient diabetes clinic visit, patients with type 2 diabetes underwent a physical examination, detailed medical history, laboratory measurement of HbA1c, and completed two questionnaires (Pediatric Quality of Life Inventory and Children’s Depression Inventory) to assess their overall quality of life and the presence of depressive symptoms. Patients were then randomized to the intervention (the buddy system) or conventional treatment (standard care). All patients were scheduled to return for follow-up at 3- and 6-mo after their initial visit. HbA1c was determined at all visits (i.e., at screening and at the 3- and 6-mo follow-up visits) and quality of life and depressive symptoms were evaluated at the screening visit and were reassessed at the 6-mo visit.

RESULTS: Ten adolescents, recruited from a pool of approximately 200 adolescents, enrolled over a two-year time period, leading to premature termination of the study. In contrast, we easily recruited motivated lay volunteers. We found no change in HbA1c from the initial to the 6-mo visit in either group, yet our small sample size limited systematic assessment of this outcome. Participants repeatedly missed clinic appointments, failed to conduct self-glucose-monitoring and rarely brought their glucometers to clinic visits. Total quality of life scores (72.6 ± 6.06) at screening were similar to previously reported scores in adolescents with type 2 diabetes (75.7 ± 15.0) and lower than scores reported in normal-weight (81.2 ± 0.9), overweight (83.5 ± 1.8), and obese youths without diabetes (78.5 ± 1.8) or in adolescents with type 1 diabetes (80.5 ± 13.1). Among adolescents who returned for their 6-mo visit, there were no differences in total quality of life scores (70.2 ± 9.18) between screening and follow-up.

CONCLUSION: Our approach, effective in adults with type 2 diabetes, was unsuccessful among adolescents and emphasizes the need for innovative strategies for diabetes treatment in adolescent patients.

A Qualitative Examination of Respondent-Driven Sampling (RDS) Peer Referral Challenges Among Young Transwomen in the San Francisco Bay Area

BACKGROUND

Efforts have focused on developing innovative recruitment strategies to engage the most marginalized of populations in public health research. Respondent-driven sampling (RDS) has been found to be an effective sampling strategy for hard-to-reach, hidden populations. Though studies have documented RDS peer referral as challenging, literature contextualizing these challenges is scant and rarely do they discuss the role of Internet technologies.

OBJECTIVE

The objective of the study was to explore reasons for peer referral challenges in a human immunodeficiency virus (HIV) risk and resilience study among a hidden population of youth, specifically, young transwomen. These findings amplify the unique opportunities Internet technologies bring to public health research and methodology.

METHODS

We conducted focused, semistructured, qualitative interviews with 16 young transwomen to investigate the reasons why youth did or did not refer peers to an RDS study for transwomen ages 16-24 in the San Francisco Bay Area. Qualitative interview data were coded and analyzed using grounded theory.

RESULTS

Participants discussed specific barriers and facilitators related to four factors that include study design, study implementation, community characteristics, and individual characteristics, which contributed to RDS peer referral challenges.

CONCLUSIONS

Our grounded theory analysis identifies important considerations for future RDS studies with hidden youth populations. Exploring research participants' experiences is integral in strengthening future epidemiologic research efforts that plan to use RDS to sample and estimate the hidden epidemics among at-risk youth and transgender women. Additionally, Internet technologies and Web-based adaptations offer solutions to traditional RDS peer referral challenges, having the potential to increase accessibility and use among hidden youth populations.