Depression outcomes associated with an intervention implemented in employment training programs for low-income adolescents and young adults.

IMPORTANCE: Recent estimates indicate that 6.5 million adolescents and young adults in the United States are neither in school nor working. These youth have significant mental health concerns that require intervention. OBJECTIVE: To determine whether a mental health intervention, integrated into an employment training program that serves adolescents and young adults disconnected from school and work, can reduce depressive symptoms and improve engaged coping strategies. DESIGN, SETTING, AND PARTICIPANTS: A quasi-experimental study was conducted; 512 adolescents and young adults newly enrolling in one employment training program site were intervention participants, while 270 youth from a second program site were enrolled as controls. Participants were aged 16 to 23 years and not in foster care. Study recruitment took place from September 1, 2008, to May 31, 2011, with follow-up data collection occurring for 12 months after recruitment. Propensity score matching adjusted for observed baseline differences between the intervention and control groups. MAIN OUTCOMES AND MEASURES: Depressive symptoms measured on a Center for Epidemiologic Studies Depression Scale (CES-D) and engaged coping strategies. RESULTS: The mean age of participants was 19 years, 93.7% were African American, and 49.4% were male. Six- and 12-month follow-up rates were 61.0% (n = 477) and 56.8% (n = 444), respectively. Males in the intervention group with high baseline depressive symptoms exhibited a statistically significant decrease in depressive symptoms at 12 months (5.64-point reduction in CES-D score; 95% CI, -10.30 to -0.96; P = .02) compared with similar males in the control group. A dosage effect was observed at 12 months after the intervention, whereby males with greater intervention exposure showed greater improvement in depressive symptoms compared with similar males with lower intervention doses (effect on mean change in CES-D score, -3.37; 95% CI, -6.72 to -0.09; P = .049). Males and females in the intervention group were more likely than participants in the control group to increase their engaged coping skills, with statistically significant differences found for males (effect on mean change in CES-D score, 0.32; 95% CI, 0.14-0.50; P = .001) and females (effect on mean change in CES-D score, 0.19; 95% CI, 0.01-0.37; P = .047) at 12 months. CONCLUSIONS AND RELEVANCE: Given the growing number of adolescents and young adults using employment training programs and the mental health needs of this population, increased efforts should be made to deliver mental health interventions in these settings that usually focus primarily on academic and job skills. Ways to extend the effect of intervention for females and those with lower levels of depressive symptoms should be explored.

Effectiveness of a brief curriculum to promote condom and health care use among out-of-school young adult males.

CONTEXT: Out-of-school black males aged 15-24 have higher levels of sexual risk-taking than in-school black males of the same age. However, few sexual risk reduction curricula are focused on out-of-school male youth. METHODS: A sexual and reproductive health intervention conducted at a Baltimore youth employment and training program in 2008-2010 was evaluated in a study involving 197 youth aged 16-24 from a predominantly black population. Ninety-eight participants received three one-hour curriculum sessions on consecutive days; 99 served as controls. At baseline and three months later, participants completed a survey assessing demographic characteristics and various knowledge, attitude and behavior measures. Regression analysis with random effects was used to assess differences between intervention participants and controls in changes in outcomes over time. RESULTS: In analyses adjusting for baseline characteristics, intervention participants showed greater improvements in outcomes between baseline and follow-up than did controls. Specifically, a male who received the intervention was more likely than a control male to report increases in knowledge of STDs and health care use (odds ratio, 1.6 for each), frequency of condom use (1.8), use of lubricant with condoms (23.6), communication with a provider about STDs (12.3) and STD testing (16.6). CONCLUSION: These findings suggest the potential benefits of integrating safer-sex and health care information into a sexual and reproductive health curriculum for out-of-school male youth.

Mobilizing for policy: using community-based participatory research to impose minimum packaging requirements on small cigars.

THE PROBLEM: Cigarette sales have declined in the United States over the past decade; however, small cigar sales have been rapidly increasing. In most urban areas, small cigars are inexpensive and are sold as singles without health warnings. PURPOSE OF ARTICLE: This paper describes a community- academic-practice partnership's (CAPP) efforts to decrease small cigar use in young adults living in Baltimore, Maryland, through legislative strategies. KEY POINTS: Survey data among young adults not in school indicated that 20% of individuals reported current small cigar use, often in combination with cigarettes. The community- academic partnership engaged the community in discussion about small cigar use in the fall of 2007. In collaboration with partners, bills were submitted to the legislative bodies for the city and state to impose minimum packaging requirements on small cigars. CONCLUSION: Collaborative partnerships between community-based organizations, public health agencies, and academic institutions can lead to policy initiatives with the potential to improve public health.

Partnering with education and job and training programs for sustainable tobacco control among Baltimore african american young adults.

BACKGROUND: Young adults are generally overlooked in tobacco control initiatives, even though they are critical to sustained success. African American young adults who are not in higher education or working are particularly vulnerable to harmful tobacco use, given high smoking rates and limited access to cessation services. OBJECTIVES: Guided by community-based participatory research (CBPR) principles, we sought to identify program and community-level strategies to reduce tobacco use among African American young adults in Baltimore. We describe the challenges and opportunities for integrating effective tobacco control into community-based education and job training programs for unemployed young adults. METHODS: As part of a longstanding community-research partnership in Baltimore, we conducted fourteen semistructured key informant interviews with leaders from city government and education and job training programs for young adults. The research design, data collection, analysis, and dissemination all included dialogue between and active contribution by both research and community partners. RESULTS: Interview data were structured into opportunities (mindset for change and desire for bonds with a trusted adult), challenges (culture of fatalism, tobacco as a stress reliever, and culture of tobacco use among young adults), and possible tobacco control solutions (tobacco education designed with and for program staff and participants and integration of tobacco issues into holistic program goals and policies). CONCLUSIONS: The emergent themes enhance our understanding of how tobacco is situated in the lives of unemployed young adults and the potential for building sustainable, community-based public health solutions.