Black Adolescent Females' Perceptions of PrEP for HIV Risk Reduction.

Preexposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) prevention is approved for use in adolescents, though uptake remains low. Black adolescent females experience higher rates of HIV transmission compared to adolescent females of other racial/ethnic groups. Increasing PrEP awareness and education among this population may be an effective strategy to mitigate disparities in HIV transmission among Black adolescent females. Twenty-seven Black adolescent females participated in focus groups which were coded using the constant comparative method of qualitative analysis to identify major themes: (1) PrEP is not commonly framed as an HIV prevention strategy for heterosexual Black adolescent females, (2) PrEP use among peers is perceived as mostly positive, (3) Adoption of PrEP among Black adolescent females is impeded by perceived barriers such as stigma, negative side effects, and adherence concerns. These findings may inform the development of targeted culturally tailored marketing and educational campaigns centered on Black heterosexual adolescent females to increase PrEP awareness and uptake in this population disproportionately affected by HIV.

Pilot-testing a Multiplayer HIV and Sexually Transmitted Infection Prevention Video Game Intervention for Black Adolescent Girls: Protocol for a Randomized Controlled Trial.

BACKGROUND: Black adolescent girls aged between 14 and 19 years are more likely than White girls to be diagnosed with a sexually transmitted infection (STI). As STI diagnosis is associated with an increase in the risk for HIV acquisition, an early intervention specifically tailored to Black adolescent girls is warranted. A web-based video game intervention has the potential to reach this demographic. Because studies of social and behavioral determinants of disease demonstrate the protective role of peer group structures on individual outcomes, a multiplayer game can facilitate opportunities to exchange and evaluate information, learn social norms, develop behavioral skills, and allow peers to influence attitudes and behavior. No prior research has examined the feasibility of a web-based multiplayer game intervention for this population. OBJECTIVE: This study describes the protocol for a randomized controlled trial (RCT) pilot-testing the feasibility, acceptability, and limited efficacy of a multiplayer game-based intervention for increasing HIV and STI testing and condom use in Black adolescent girls. METHODS: We enrolled 79 Black adolescent girls aged 14 to 19 years residing in the United States into a 2-arm parallel RCT. The intervention is a theory-based, community-informed, multiplayer game that can be played with peers on the web using videoconferencing software. The goal of the game is to empower Black adolescent girls to make healthy decisions regarding dating, relationships, and sex, thus reducing HIV and STI infection. Control condition participants received a list of resources after playing a time and attention control game. All study procedures were conducted via the internet. We conveniently sampled Black adolescent girls using web-based advertisements. Study assessments occurred at enrollment, 1 week, 1 month, and 4 months after enrollment. The primary outcome of this study is increased HIV and STI testing by Black adolescent girls. Secondary outcomes include increased condom use, self-efficacy to use condoms, positive attitudes toward condom use, intentions, harm perceptions, HIV and STI and pre-exposure prophylaxis knowledge, positive sexual norms, sexual communication with partners, and reduced incidence of sexual risk behaviors associated with HIV and STI transmission. Secondary outcomes also included assessment of intervention feasibility and acceptability. RESULTS: From February to April 2022, a total of 79 Black adolescent girls were enrolled, with 40 (51%) having been randomized into the intervention condition and 39 (49%) into the control condition. At baseline, participant ages ranged from 14 to 19 (mean 16.4, SD 1.23) years. CONCLUSIONS: Web-accessible game interventions overcome common impediments of face-to-face interventions presenting a unique opportunity to reach Black adolescent girls and improve their sexual health and self-efficacy. Trial data will provide information about the limited efficacy of the intervention and inform future web-based studies and a larger RCT aimed at improving the sexual health of Black adolescent girls. TRIAL REGISTRATION: ClinicalTrials.gov NCT04108988; https://clinicaltrials.gov/ct2/show/NCT04108988. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/43666.

Feeling Invisible and Unheard: A Qualitative Exploration of Gendered-Racist Stereotypes Influence on Sexual Decision Making and Mistreatment of Black Teen Girls.

Gendered racism can impact how Black teen girls perceive themselves in relation to the world and influence their behaviors. This form of discrimination tends to manifest in stereotypes that promote the victimization and mistreatment of Black teen girls. This qualitative study, using Black feminist thought through a Black Girlhood lens as a guiding framework, aims to understand how Black teen girls are affected by gendered-racist stereotypes and how these stereotypes impact sexual decision making among this group. Using a sample of (N = 27) Black teen girls, three major themes arose: (1) experiencing the effects of racist-sexist stereotypes, (2) feeling powerless and invisible due to stereotypes, and (3) navigating the pressure to have sex due to stereotypes. Implications for this study include incorporating elements of Black Feminist Thought through a Black girlhood lens within prevention programing while also providing Black teen girls with the tools to challenge negative stereotypes with support from adult allies in school and family settings.

How Black Teen Girls Navigate Social Media to Form Romantic Relationships.

The purpose of this study was to explore the use of social media within the context of heterosexual Black teen girls' romantic partner selection processes. To better understand Black teen girls' experiences, five focus groups (N = 27; aged 14-18 years) were conducted over Zoom. An inductive thematic analysis revealed four major themes: (1) the use of different platforms to gather different types of information, (2) the rules of social media scouting, (3) detecting partner qualities through social media, and (4) exploring Black teen girls' experience with social media and dating. Participants in our study primarily used Instagram to understand a potential partner's true self, while Twitter was used to assess a potential partner's political leanings. Our participants shared numerous "rules" related to the partner-scouting process. Black teen girls in our study explained that photos index a potential partner's style and hygiene, while memes were used to gauge sense of humor compatibility. More specific to Black teen girls, across all focus groups, participants shared their experiences of racism and bias, such as being associated with Black stereotypes, cultural invalidation, and being accused of "acting White." Although teen girls of various racial and ethnic groups may use social media to vet romantic partners, findings reveal that Black teen girls navigate social media in a unique way, including being highly attuned to signs of bias. Our findings suggest that in the first few months of COVID-19 social distancing had little impact on our participant's practice of using social media to vet potential romantic partners.

Evaluation of a virtual reality E-cigarette prevention game for adolescents.

OBJECTIVE: To test preliminary efficacy and acceptability of Invite Only VR: A Vaping Prevention Game (Invite Only VR), an electronic cigarette (e-cigarette) prevention game that uses virtual reality (VR) hardware. METHODS: 285 adolescents (146 boys; ages 11-14; M = 12.45 years; SD = 0.57) were enrolled in this non-equivalent control groups design through their middle school. Participants who played Invite Only VR for 1.5 h were compared to treatment as usual at 4 timepoints: baseline, post gameplay, 3 and 6 months. Evidence of the efficacy of the game to influence e-cigarette use, e-cigarette knowledge, nicotine addiction knowledge, perceived addictiveness of e-cigarettes, perceived likelihood of using e-cigarettes, perceptions of harm, self-efficacy to refuse, social approval of e-cigarettes, and e-cigarette social perceptions was assessed using mixed between-within subjects ANOVAS. Intervention acceptability was indicated by measures of gameplay experience/satisfaction, VR experience, and perceived responsibility for game-based decisions. RESULTS: From baseline to 6 months, Invite Only VR players improved in e-cigarette knowledge, nicotine addiction knowledge, perceived addictiveness of e-cigarettes, perceptions of harm, and social perceptions about e-cigarette use compared to the control group. No significant changes were observed for the other dependent variables, including e-cigarette use. Ratings of gameplay experience and satisfaction, VR experience, and game-based decisions were high. CONCLUSIONS: Invite Only VR may help players develop knowledge about e-cigarettes and nicotine addiction, as well as encourage the development of healthy harm and social perceptions regarding e-cigarette use that persist 6 months beyond gameplay. Adolescents' satisfaction with the VR gameplay indicates preliminary intervention acceptability.