Examining the Bidirectional Associations Between Sleep Duration, Screen Time, and Internalizing Symptoms in the ABCD Study.

PURPOSE: The likelihood of meeting sleep duration and screen time guidelines decreases as children develop toward adolescence. Simultaneously, the prevalence of internalizing symptoms increases. The purpose of this paper was to examine the bidirectional associations between sleep duration and screen time with internalizing symptoms in a one-year longitudinal study starting in late childhood. METHODS: Participants were 10,828 youth (47.8% female) enrolled in the Adolescent Brain Cognitive Development Study. At baseline (mean age 9.9 years) and one-year follow-up (mean age 10.9 years), youth self-reported screen time for weekdays and weekend days. Responses were separately dichotomized as >2 versus ≤2 hours/day (meeting behavioral guidelines). Caregiver-reported youth sleep duration was dichotomized as <9 versus 9-11 hours/night (meeting behavioral guidelines). Caregivers reported internalizing symptoms via the child behavior checklist. The withdrawn/depressed, anxious/depressed, and somatic symptom child behavior checklist subscale t-scores were separately dichotomized as ≥65 (borderline clinical levels of symptoms and above) versus <65. Analyses were gender-stratified. RESULTS: In females, longer baseline sleep duration was protective against withdrawn/depressed symptoms (odds ratio [OR] 0.6, 95% confidence interval [CI] 0.4-0.8) and somatic complaints (OR 0.8, 95% CI 0.6-0.97) one year later. In females, greater baseline weekend screen time was associated with increased risk of withdrawn/depressed symptoms (OR 1.6, 95% CI 1.1-2.2) one year later. No other significant associations were observed. DISCUSSION: Longitudinal associations between sleep duration, weekend screen time, and internalizing symptoms were unidirectional (behavior preceding internalizing symptoms), among females only, and specific to withdrawn/depressed and somatic symptoms. These prospective study findings warrant attention and inform future research in this cohort.

Community and partner engagement in dissemination and implementation research at the National Institutes of Health: an analysis of recently funded studies and opportunities to advance the field.

BACKGROUND: As the focus has grown in recent years on both engaged research and dissemination and implementation (D&I) research, so too has federal funding to support these areas. The purpose of this analysis is to provide an overall perspective about the range of practices and approaches being used to engage partners in D&I research, with special attention to disparities-relevant research, and to identify gaps and opportunities in research funded by the US National Institutes of Health (NIH) in this space. METHODS: This analysis examined a portfolio of active D&I research grants funded in fiscal years 2020 and 2021 across the NIH. Grant applications were deductively coded and summary statistics were calculated. Cross-tabulations were used to identify trends by engagement and disparities foci. RESULTS: There were 103 grants included in the portfolio, of which 87% contained some form of community or partner engagement, and 50% of engaged grants were relevant to health disparities. Engagement was planned across the research continuum with each study engaging on average 2.5 different partner types. Consultation was the most common level of engagement (56%) while partnership was the least common (3%). On average, each study used 2.2 engagement strategies. Only 16% of grants indicated formally measuring engagement. Compared to non-disparities studies, disparities-relevant studies were about twice as likely to engage partners at the higher levels of partnership or collaboration (19% vs. 11%) and were also more likely to be conducted in community settings (26% vs. 5%). CONCLUSIONS: Based on this portfolio analysis, D&I research appears to regularly integrate engagement approaches and strategies, though opportunities to deepen engagement and diversify who is engaged remain. This manuscript outlines several gaps in the portfolio and describes opportunities for increasing engagement to improve the quality of D&I research and application to advancing health equity. In addition, opportunities for leveraging the consistent and systematic application of engagement approaches and strategies to advance the science of engagement are discussed.

Preliminary effectiveness and implementation outcomes of the IMARA-South Africa sexual health intervention on adolescent girls and young women: A pilot randomized trial.

Family-based interventions may help reduce the risk of HIV and other sexually transmitted infections (STI) among adolescent girls and young women (AGYW) in sub-Saharan Africa but few have been tested. We examined the preliminary effectiveness and implementation outcomes of Informed, Motivated, Aware, and Responsible Adolescents and Adults-South Africa (IMARA-SA), an evidence-based intervention for South African AGYW (15-19 years) and their female caregivers. We piloted IMARA-SA in the Western Cape using an individually randomized experimental design and average follow-up at 11 months. Primary outcomes were HIV Testing and Counselling (HTC) uptake, STI incidence (gonorrhea, chlamydia), and pre-exposure prophylaxis (PrEP) uptake. Secondary outcomes were self-reported sexual risk behavior (condom use at last sex, consistency of condom use, substance use during sex, and number of sexual partners) and PrEP adherence. We examined four implementation outcomes: reach, feasibility, acceptability, and fidelity. Data from 59 AGYW (mean = 17.2 years) were analyzed at baseline (n = 29 from IMARA-SA, 30 from a health promotion control group). At follow-up, 51 (86%) completed surveys and 39 (66%) presented for HTC, STI testing, and/or PrEP. Compared to controls, fewer IMARA-SA participants tested positive for an STI (22% versus 38%), more IMARA-SA participants took up PrEP (68% versus 45%), and four of five secondary outcomes favored the IMARA-SA group at follow-up. These differences did not reach statistical significance. HTC uptake at follow-up was 100% in both groups. All AGYW-FC dyads agreed to participate in the study (reach). In the IMARA-SA group, 76% of dyads completed the intervention (feasibility), and over 76% of acceptability ratings from AGYW and their FC had the highest Likert rating. Fidelity of intervention delivery was 95%. IMARA-SA is a promising strategy for reducing HIV/STI risk among South African AGYW. We found strong evidence of reach, feasibility, acceptability, and fidelity. A fully powered randomized controlled trial is warranted. Trial registration: Clinical trials.gov registration number: NCT05504954.

Emerging research areas and contributions of NIH in violence research across the lifespan and throughout different settings.

This commentary provides background for NIH's interest in research designed to better understand the causes and consequences of violence and the development, evaluation, and implementation of preventive and treatment interventions to address the resulting trauma, injuries, and mortality from violence. The manuscript describes the context that contributed to a range of initiatives from the NIH focused on violence research, with a particular emphasis on firearms violence prevention research, and opportunities and gaps for future research.

Efforts to advance NIH-funded behavioral and social sciences research on structural racism and health.

This commentary provides background and context for the increasing attention to research designed to better understand and address the impact of structural racism on health, with particular attention to the role of the behavioral and social sciences. The manuscript describes the impetus provided to this work by recent public health crises of COVID-19 and the racial justice movement that emerged following the murder of George Floyd in the summer of 2020. A range of initiatives from the National Institutes of Health (NIH) focused on structural racism and health equity are discussed in this context and opportunities and gaps for future research are identified.

Harmonizing Implementation and Outcome Data Across HIV Prevention and Care Studies in Resource-Constrained Settings.

Harmonizing measures across studies can facilitate comparisons and strengthen the science, but procedures for establishing common data elements are rarely documented. We detail a rigorous, 2-year process to harmonize measures across the Prevention And Treatment through a Comprehensive Care Continuum for HIV-affected Adolescents in Resource Constrained Settings (PATC3H) consortium, consisting of eight federally-funded studies. We created a repository of measured constructs from each study, classified and selected constructs for harmonization, and identified survey instruments. Measures were harmonized for implementation science, HIV prevention and care, demographics and sexual behavior, mental health and substance use, and economic assessment. Importantly, we present our harmonized implementation science constructs. A common set of implementation science constructs have yet to be recommended in the literature for low-to-middle-income countries despite increasing recognition of their importance to delivering and scaling up effective interventions. Drawing on RE-AIM (Reach Effectiveness Adoption Implementation Maintenance) and the Implementation Outcomes Framework, items were harmonized for staff/administrators and study participants to measure reach, adoption, implementation, maintenance, feasibility, acceptability, appropriateness, and fidelity. The process undertaken to harmonize measures and the codified set of implementation science measures developed by our consortium can inform future data harmonization efforts, critical to strengthening the replication and generalizability of findings while facilitating collaborative research-especially in resource-limited settings. We conclude with recommendations for research consortia, namely ensuring representation from all study teams and research priorities; adopting a flexible, transparent, and systematic approach; strengthening the literature on implementation science harmonization; and being responsive to life events (e.g., COVID-19). Supplementary Information: The online version contains supplementary material available at 10.1007/s43477-022-00042-7.

Accelerating adolescent HIV research in low-income and middle-income countries: evidence from a research consortium.

OBJECTIVE: Many adolescents and young adults (AYA) have unmet HIV prevention needs. We describe the Prevention and Treatment through a Comprehensive Care Continuum for HIV-affected Adolescents in Resource Constrained Settings (PATC3H) consortium organization, transition milestones, and youth engagement strategies. The PATC3H consortium focuses on reducing HIV incidence and related health disparities among AYA. DESIGN AND METHODS: Organizational data were obtained from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and supplemented with a brief survey completed by study principal investigators. Transition from the initial phase (years 1 and 2) to the subsequent phase (years 3 and 5) was contingent on meeting prespecified milestones. We reviewed the structure and function of the research consortium, identified shared elements of transition milestones, and examined common youth engagement strategies. RESULTS: The PATC3H consortium supports eight research studies through a milestone transition mechanism. The consortium includes AYA HIV research studies in seven countries - Brazil, Kenya, Mozambique, Nigeria, South Africa, Uganda, and Zambia. The NIH request for applications required transition milestones that included early consultation with stakeholders. The transition milestones required by NIH for the eight studies included early consultation with health and policy stakeholders, pilot intervention data, and commitment from national government stakeholders. All studies provided multiple pathways for AYA engagement, including AYA advisory boards and youth-led research studies. CONCLUSION: Data suggest that requiring milestones to transition to the final phase may have facilitated health and policy stakeholder engagement and enhanced formative assessment of regulatory protocols. These data have implications for designing engaged research studies in low and middle-income countries.

An individually randomized controlled trial of a mother-daughter HIV/STI prevention program for adolescent girls and young women in South Africa: IMARA-SA study protocol.

BACKGROUND: South Africa has the world's largest HIV epidemic, but South African adolescent girls and young women (AGYW) acquire HIV at twice the rate of and seroconvert on average 5-7 years earlier than their male peers. Female caregivers (FC) are an untapped resource for HIV/STI prevention in South Africa and offer a novel opportunity to strengthen AGYW prevention efforts. This study will evaluate the effectiveness and cost-effectiveness of an evidence-based mother-daughter HIV/STI prevention program tested in the United States and adapted for South Africa, Informed Motivated Aware and Responsible Adolescents and Adults (IMARA), to decrease STI incident infections and increase HIV testing and counseling (HTC) and PrEP uptake in AGYW. METHODS: This is a 2-arm individually randomized controlled trial comparing IMARA to a family-based control program matched in time and intensity with 525 15-19-year-old Black South African AGYW and their FC-dyads in Cape Town's informal communities. AGYW will complete baseline, 6-, and 12-month assessments. Following randomization, AGYW-FC dyads will participate in a 2-day group workshop (total 10 h) that includes joint and separate mother and daughter activities. Primary outcomes are AGYW STI incidence, HTC uptake, and PrEP uptake at 6 months. Secondary outcomes are AGYW STI incidence, HTC uptake, and PrEP uptake at 12 months, sexual behavior (e.g., condom use, number of partners), HIV incidence, and ART/PrEP adherence and intervention cost-effectiveness. AGYW who test positive for a STI will receive free treatment at the study site. HIV positive participants will be referred to ART clinics. DISCUSSION: Primary prevention remains the most viable strategy to stem new STI and HIV transmissions. HIV and STI disparities go beyond individual level factors, and prevention packages that include supportive relationships (e.g., FC) may produce greater reductions in HIV-risk, improve HTC and PrEP uptake, and increase linkage, retention, and adherence to care. Reducing new HIV and STI infections among South African AGYW is global public health priority. TRIAL REGISTRATION: ClinicalTrials.gov Number NCT04758390 , accepted 02/16/2021.

Providing Incentives to Youth Participants in Research: A Literature Review.

The provision of financial incentives to youth involved in research remains an understudied and contentious issue. Although the practice is common and often accepted, a comprehensive understanding of the current status of the literature regarding the potential benefits and limitations is lacking. The primary question this article seeks to answer is as follows: "What are the concerns and best practices identified in the literature for the appropriate and ethical provision of incentives to children and adolescents?" Following a thorough review and screening process, 25 articles were selected and central themes were identified within them. Themes include the following: the wage-payment model, effectiveness for recruitment, effectiveness for retention, financial versus alternative incentives, coerciveness, influence on validity of results, and other ethical dilemmas. Gaps in the literature are discussed. Overall, the literature suggests financial incentives can be provided appropriately to children as long as necessary precautions are taken.

Commentary on Scaling-up Evidence-based Interventions in US Public Systems to Prevent Behavioral Health Problems.

As evidence-based interventions (EBIs) to prevent mental, emotional, and behavioral health problems continue to become available, approaches for implementation in systems and settings, at scale, are needed. The article, Scaling-up Evidence-based Interventions in U.S. Public Systems to Prevent Behavioral Health Problems: Challenges and Opportunities (Fagan et al. 2019) examines five large, complex public systems (behavioral health, child welfare, education, juvenile justice, and public health) that have adopted and implemented EBIs in various ways and presents common factors that support scale-up in these systems. This commentary builds on the authors' strategic approach to offer a few additional considerations-issues of sustainability, ways of thinking about knowledge creation, and use of systems science/modeling approaches-to address scale-up in public systems. Moreover, the focus on public systems provides an opportunity to consider how the implementation and sustainment of EBIs might more directly address social determinants of health that are relevant across policy areas and public systems.

Victim Offender Overlap: Dual Trajectory Examination of Victimization and Offending among Young Felony Offenders over Seven Years.

The relationship between victimization and offending has been shown consistently across different samples, settings, and crime types. This study uses data from the Pathways to Desistance Study to examine dual trajectories of offending between the ages of 15 and 24 in a sample of male felony offenders. The dual trajectory models demonstrate substantial convergence in victimization and offending. And while there are sizable numbers of youth who continue to be victimized, but desist or decrease in their offending behaviors, very few youth continue to offend in the absence of continued victimization. This study also proposes and tests three criminological theories that have been employed as explanations for the victim-offender overlap - low self-control, lifestyles/routine activities, and street-code attitudes. The logistic regression results indicate that involvement in risky and/or unstructured, unsupervised activities is a key correlate of the victim-offender overlap. The strength of the relationship between routine activity variables and the victim-offender overlap supports the provision of structured, supervised activities for youth and young adults as a way of preventing future victimization and offending, particularly among youth who have high exposure to violence.

Taking Stock of Behavioral Measures of Adolescent Dating Violence.

The past 2 decades have witnessed an increase in dating violence awareness and research. As the field evolves, it is critical to examine the definition and measurement of adolescent dating violence. This article summarizes the behavioral measures of adolescent dating violence used in the field. Based on a review of the literature and federally funded studies, we identified 48 different measures. The most commonly used measures were the Conflict Tactics Scale-2, the Safe Dates Scale, and the Conflict in Adolescent Dating Relationship Inventory, which all examine aspects of psychological, physical, and sexual violence. Researchers also adapted or created their own measures. This article concludes with a discussion of developments for consideration as the field moves forward.

Teen dating violence: building a research program through collaborative insights.

The National Institute of Justice (NIJ) has an emerging portfolio of research in the area of teen dating violence (also known as adolescent relationship abuse). This article begins with a discussion of the developments that prompted NIJ to focus on teen dating violence. Next, the article highlights specific accomplishments and contributions that NIJ has made to helping develop knowledge and scientific understanding of adolescent relationship abuse, particularly around the prevention of teen dating violence perpetration and victimization. This is followed by a presentation of some of the key findings from NIJ-funded research. We then move to a discussion of some of the complex issues around definition, measurement and research methods and how NIJ has been involved in addressing those issues. The article concludes with some thoughts about the intersection of teen dating violence research, policy, and practice and highlights several research gaps that are in need of additional attention.