"Nobody Wants to Have Conversation About HIV." A Thematic Analysis of in-Depth Interviews With Black Adolescent Women and Providers About Strategies for Discussing Sexual Health and HIV Prevention.

BACKGROUND: Black adolescent girls and young women (AGYW) in the US Southeast are disproportionately burdened by HIV. Infrequent assessment of sexual health in clinical encounters may contribute to low preexposure prophylaxis uptake for this population. This study explores Black AGYW and providers' perspectives on engaging in discussions about sexual health, including preexposure prophylaxis. METHODS: In-depth interviews (IDIs) were conducted with Black AGYW aged 14 to 24 years and health care providers (MD, DO, NP, PA) who self-reported caring for Black AGYWs in Alabama. In-depth interviews were grounded in Andersen's Behavioral Model of Health Service Utilization to explore barriers and facilitators to sexual health discussions. After separate analyses, AGYW and provider IDIs were aggregated and reanalyzed using thematic analysis to identify themes related to their views on ways to improve Black AGYW engagement in sexual health discussions while in clinical settings. RESULTS: Twelve Black AGYW and 11 providers completed IDIs. Client median age was 21 years, representing 9 Alabama counties. Providers were predominately non-Hispanic White (82%), female (73%), and physicians (64%). Themes about ways to improve sexual health discussions included the following: (1) improve sexual health education for providers and adolescents, (2) normalize conversations in clinical settings, and (3) engage communities to continue these conversations outside of clinical settings. CONCLUSIONS: Sexual health and HIV prevention discussions with Black AGYW are not occurring. This study is one of the first to identify and highlight Black AGYW and provider-identified shared strategies for improving these discussions. Operationalizing these strategies is crucial to facilitating these discussions.

A Multicomponent Intervention to Train and Support Family Medicine Providers to Promote Pre-exposure Prophylaxis (PrEP) for Adolescent Girls and Young Women in the Deep South: Protocol for the PrEP-Pro Study.

BACKGROUND: Pre-exposure prophylaxis (PrEP) is a highly effective biomedical prevention intervention and a major strategy for reducing the HIV burden in the United States. However, PrEP provision and uptake remain lower than estimated needs, and in ways that may exacerbate HIV disparities among Black adolescent girls and young women in the southern United States. Data suggest that gaps in provider knowledge of HIV epidemiology and PrEP and skills assessing sexual health practices are important barriers to provision and uptake, with limited evidence-based interventions to address these gaps. OBJECTIVE: This paper describes the "PrEP-Pro" intervention, a multicomponent intervention to train and support family medicine (FM) trainees to promote PrEP for adolescent girls and young women in Alabama. METHODS: The PrEP-Pro intervention comprises 3 main components guided by the Capability-Opportunity-Motivation-Behavior (COM-B) model for behavioral change and the Consolidated Framework for Implementation Research (CFIR): (1) provider HIV epidemiology and PrEP education, (2) sexual history taking, and (3) PrEP Champions. In phase 1, we will work with community advisory boards (providers and clients) and then conduct focus groups with FM trainees to adapt content to train FM residents on HIV epidemiology and PrEP and develop implementation strategies, including provider-facing tools and client-facing educational materials. In phase 2, we will pretest and then pilot-test the initially adapted PrEP-Pro intervention with FM trainees. FM trainees will complete baseline, 3-, and 6-month questionnaires post PrEP-Pro intervention. We will also conduct in-depth interviews (IDIs) with FM pilot participants, adolescent girls and young women who accessed care after the PrEP-Pro pilot, and key stakeholders. The primary outcomes are PrEP-Pro acceptability and feasibility, which would be assessed using validated instruments at months 3 (among pretest participants) and 6 (among pilot participants). Secondary outcomes will also be assessed, including PrEP knowledge, sexual history-taking attitudes and practices, PrEP prescriptions among adolescent girls and young women encounters, and sexually transmitted infections (STIs) and HIV testing among adolescent girls and young women encounters in 6 months. RESULTS: Study results will be disseminated to practices, state health officials, and other key stakeholders to solicit feedback on implementation opportunities and challenges to inform a hybrid effectiveness implementation trial. Our results will also be presented at local and national conferences and submitted to peer-reviewed journals. CONCLUSIONS: As PrEP grows, there is a pressing need to train FM providers and develop appropriate, contextually relevant tools to support PrEP implementation. The PrEP-Pro intervention is a multicomponent intervention to train FM residents across Alabama on sexual history-taking, PrEP provision for adolescent girls and young women, and supporting practice-based PrEP Champions. The PrEP-Pro intervention is anticipated to increase PrEP prescriptions for adolescent girls and young women and expand comprehensive sexual and reproductive health care for adolescent girls and young women in rural and urban Alabama. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/44908.

A Disability-Inclusive Healthcare-to-Well-Being Translational Science Framework.

The recent World Health Organization report on disability noted that people with disabilities (PWD) have many unmet health and rehabilitation needs, face numerous barriers to accessing healthcare and specialized services, and have overall worse health than people without disability. In view of this urgency to better identify and address health inequities systematically, we convened an expert panel of 14 stakeholders to develop a strategic plan that addresses this issue. The panel identified two major obstacles to quality healthcare services for PWD: (1) lack of coordination between the various healthcare sectors and community well-being programs and (2) substantial challenges finding and accessing healthcare services that meet their specific needs. The expert stakeholder panel noted that well-being self-management programs (both online and in person) that are easily accessible to PWD are critically needed. PWD must transition from being cared for as patients to individuals who are able to self-manage and self-advocate for their own health and well-being plans and activities. The proposed strategic plan offers providers and local communities a framework to begin addressing accessible and appropriate healthcare-to-well-being services and programs for PWD in managing their health in partnership with their healthcare providers.

PrEP Prescription for Black Adolescent Girls and Young Women in Alabama: Findings from a Survey of Healthcare Providers.

Black adolescent girls and young women (AGYW) are disproportionately affected by HIV in the United States. HIV pre-exposure prophylaxis (PrEP) is effective for HIV prevention, but prescription rates remain low. We conducted a survey of medical providers caring for Black AGYW in Alabama to explore PrEP prescription practices. While over half of the N = 36 providers reported minimal HIV testing of AGYW in clinic, most (N = 29, 81%) reported feeling confident discussing HIV prevention. Most reported willingness to prescribe PrEP to Black AGYW (58%-72%), but only 11 (31%) had prescribed PrEP to any female client. Low familiarity with CDC guidelines (N = 20, 56%) and PrEP options (N = 19, 53%) were barriers to prescription. Prescribing PrEP to AGYW was associated with provider training, with internal medicine providers being least likely to prescribe. These findings support the need to develop training tools to directly address unique training needs of providers who care for this population.

"We Feel Like Everybody's Going to Judge us": Black Adolescent Girls' and Young Women's Perspectives on Barriers to and Opportunities for Improving Sexual Health Care, Including PrEP, in the Southern U.S.

Black adolescent girls and young women (AGYW) are disproportionately affected by HIV in the southern U.S.; however, PrEP prescriptions to Black AGYW remain scarce. We conducted in-depth interviews (IDIs) with Black AGYW ages 14-24 in Alabama to explore opportunities for and barriers to sexual health care including PrEP prescription. Twelve AGYW participated in IDIs with median age 20 (range 19-24). All reported condomless sex, 1-3 sexual partners in the past 3 months, and 6 reported prior STI. Themes included: 1) Stigma related to sex contributes to inadequate discussions with educators, healthcare providers, and parents about sexual health; 2) Intersecting stigmas around race and gender impact Black women's care-seeking behavior; 3) Many AGYW are aware of PrEP but don't perceive it as an option for them. Multifaceted interventions utilizing the perspectives, voices, and experiences of Black cisgender AGYW are needed to curb the HIV epidemic in Alabama and the U.S. South.

Getting to the Sandbar: Understanding the Emotional Phases of COVID-19 Among College and University Students.

This paper provides a framework for understanding the emotional and behavioral responses of college and university students during the COVID-19 pandemic. It builds on the Substance Abuse and Mental Health Services Administration (SAMHSA) Phases of Disaster Model and Maslow's Hierarchy of Needs. Additionally, we conceptualize a new phase in the Phases of Disaster Model, which we refer to as the "Sandbar Phase," to address the unique factors of COVID-19 for college and university students. For each phase, we discuss the expected timeline and the associated emotional reactions, behaviors, and applications of Maslow's Hierarchy of Needs during COVID-19 for college and university students. Our proposed model aims to reveal short- and long-term effects of COVID-19 on the mental health of college and university students and be a resource in the development of effective mitigation efforts to diminish any psychological deficits as the result of future disasters and/or traumatic events.

Trajectories of self-regulatory driving practices: Role of learner phase practice.

INTRODUCTION: Previous research suggests that driving practice in diverse contexts may contribute to earlier licensure and improve driving skills among teen drivers. However, few studies have examined the role of practice diversity in driving outcomes post-licensure. Specifically, examining self-regulatory driving practices post-licensure may provide insight into the extent to which teens choose to avoid driving various environments. The current study examined the relationship between learner phase driving practice diversity and teen self-regulatory driving practices over the first six months of licensure. METHODS: Fifty-six newly licensed 16-year-olds reported pre-licensure practice diversity, driving exposure and, self-regulatory driving practices at three timepoints (within 2 weeks of licensure and at 3 and 6 months post-licensure). RESULTS: Multi-level models revealed self-regulatory driving practices significantly decreased over the first six months of independent driving. Practice in complex environments (e.g., on a commercial road, on a highway, etc.) was associated with fewer self-regulatory driving practices at baseline. Practice in simple environments (e.g., in a residential area, in a parking lot) was associated with more self-regulatory driving practices at baseline. Practice driving at night and in bad weather conditions predicted greater post-licensure self-regulation of driving in those specific environments. CONCLUSION: This study reinforces the importance of practice diversity for teens before independent driving, as early practice can have implications for self-regulatory driving practices immediately upon licensure. Future research examining this topic may inform parent-based interventions to maximize teen driver safety during the critical post-licensure period.

Adolescent Chlamydia Rates by Region, Race, and Sex: Trends From 2013 to 2017.

INTRODUCTION: Chlamydia is the most common bacterial sexually transmitted infection in the United States. Adolescents (ages 15-19 years) have the highest infection rate, second only to young adults (ages 20-24 years). The purpose of this secondary data analysis is to examine trends from 2013 to 2017 in adolescent chlamydia rates by region, race, and sex. METHOD: Adolescent chlamydia rate data were obtained from the Center for Disease Control's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention database. Descriptive statistics were used to analyze the trends. RESULTS: The overall trend in male and female adolescent chlamydia rates increased from 2013 to 2017. Specifically, the trend increased faster in males, White adolescents, and those in the Northeast and Midwest regions of the country. DISCUSSION: Health care providers are uniquely positioned to positively affect adolescent chlamydia rates through targeted sexual health discussions and increased screening for sexually transmitted infections.

Adolescents' perceptions of sexual health education programs: An integrative review.

INTRODUCTION: Adolescents are key stakeholders in sexual health education, yet they are rarely consulted when developing sexual health programs. Their voices are integral to improving the delivery of relevant and appropriate school-based sexual health education to promote safer adolescent sexual behaviors. METHODS: An integrative review was conducted utilizing three databases: Cumulative Index of Nursing and Allied Health Literature (CINAHL) Complete, PubMed, and Education Resources Information Center (ERIC). The PRISMA and matrix method were used to search the literature and synthesize the findings from 16 articles regarding adolescent perceptions of school-based sexual health education. RESULTS: The main themes that emerged from this review included: (a) factors influencing adolescent perceptions of sexual health education programs, (b) characteristics of good sexual health education programs, and (c) areas of improvement in sexual health education programs. CONCLUSION: Adolescents overwhelmingly requested honest, comprehensive content delivered by nonjudgmental, well-educated health professionals in a comfortable environment.

Neighbourhood-level deprivation indices and postpartum women's health: results from the Community Child Health Network (CCHN) multi-site study.

BACKGROUND: Area-level socioeconomic characteristics have been shown to be related to health status and mortality however, little is known about the association between residential community characteristics in relation to postpartum women's health. METHODS: Data from the longitudinal, multi-site Community Child Health Network (CCHN) study were used. Postpartum women (n = 2510), aged 18-40 were recruited from 2008 to 2012 within a month of delivery. Socioeconomic data was used to create deprivation indices. Census data were analysed using principal components analysis (PCA) and logistic regression to assess the association between deprivation indices (DIs) and various health indicators. RESULTS: PCA resulted in two unique DIs that accounted for 67.5% of the total variance of the combined all-site area deprivation. The first DI was comprised of variables representing a high percentage of Hispanic or Latina, foreign-born individuals, dense households (more than one person per room of residence), with less than a high-school education, and who spent more than 30% of their income on housing costs. The second DI was comprised of a high percentage of African-Americans, single mothers, and high levels of unemployment. In a multivariate logistic regression model, using the quartiles of each DI, women who reside in the geographic area of Q4-Q2 of the second DI, were almost twice as likely to have more than three adverse health conditions compared to those who resided in the least deprived areas. (Q2vs.Q1:OR = 2.09,P = 0.001,Q3vs.Q1:OR = 1.89,P = 0.006,Q4vs.Q1:OR = 1.95,P = 0.004 respectively). CONCLUSIONS: Our results support the utility of examining deprivation indices as predictors of maternal postpartum health.

Engaging African American Youth in the Development of a Serious Mobile Game for Sexual Health Education: Mixed Methods Study.

BACKGROUND: Although teen pregnancy rates decreased dramatically in the United States over the past decade, the rates of sexually transmitted infections (STIs) among adolescents and young adults increased. STI rates disproportionately affect African American youth and young adults. Innovative, accessible, and culturally relevant sexual health interventions are urgently needed. OBJECTIVE: This study aimed to identify the optimal modality for a game-based sexual health intervention; develop the educational, entertainment, and technological aspects of the serious game; and demonstrate its usability and acceptance by the target population. METHODS: This project was grounded in formative data collection with community-based participatory research principles and practices combined with a user-centered design and development approach. Sexually Active Adolescent-Focused Education (SAAFE) was developed using input and feedback from African American youths aged 15 to 21 years who participated in a youth advisory board and focus group discussions to inform the co-design and cocreation of the serious game. The process was highly iterative with multiple sessions for user input following design changes. It proceeded in 3 stages. Social cognitive theory and problem-solving theory were leveraged to provide evidence-based, trauma-informed education through a serious game. Usability testing assessed the quality of user experience with the prototype. RESULTS: Across all 3 stages, a total of 86 self-identified African American males and females aged 15 to 21 years from the District of Columbia and Birmingham, Alabama, participated. Participants requested a dating simulation game. They wanted SAAFE to be customizable, realistic, entertaining, educational, modern, and experiential, linking consequences to their gameplay decisions. Usability testing resulted in an initial System Usability Survey score of 77.7, placing the game in the 82nd percentile and above average for usability. CONCLUSIONS: Initial results suggest that the SAAFE prototype is a promising intervention to engage African American youth in sexual health education using a role-playing game. If proven efficacious, the game has the potential to meet the need for sex education, counterbalance unhealthy portrayals of sex in popular media, and respond to the disparities in the STI epidemic.

Reducing the African American HIV Disease Burden in the Deep South: Addressing the Role of Faith and Spirituality.

Nearly half of HIV infections in the United States are concentrated among African Americans, and over half of new HIV infections occur in the South. African Americans have poorer outcomes in the entire continua of HIV and PrEP care. Complex social, structural, and behavioral factors contribute to our nation's alarming racial disparities in HIV infection, particularly in the Deep South. Despite the importance of faith, spirituality and religious practice in the lives of many African Americans, there has been little scientific investment exploring how African Americans' religious participation, faith and spirituality may impact our nation's HIV epidemic. This article summarizes the state of the science on this critical issue. We also identify opportunities for new scholarship on how faith, spirituality and religious participation may impact HIV care continuum outcomes in the South and call for greater federal research investment on these issues.

Love with No Exceptions: A Statewide Faith-Based, University-Community Partnership for Faith-Based HIV Training and Assessment of Needs in the Deep South.

This project established a faith-based, university-community partnership with the African Methodist Episcopal (AME) church in Alabama to develop a statewide training model to address HIV knowledge and stigma, promote discussion and generate action plans to address HIV in the Deep South. A community-engaged research team consisting of church leadership and university researchers developed and implemented the model, "Love with No Exceptions." Mixed methods were used to evaluate the model delivered in 3-h sessions in five state regions (N = 146 clergy and laity). The majority of participants reported feeling better prepared to serve those living with or affected by HIV and would implement education and awareness activities in their churches. Participants' HIV knowledge increased from pre- to post-training. Stigma-related attitudes showed minor changes from baseline. These results reflect that partnerships between academic institutions and churches can deliver promising steps towards impactful HIV education in the Deep South.

Effective mentoring of underrepresented doctoral trainees and early career scholars in the biobehavioral and health sciences: A developmental framework to maximize professional growth.

Effective mentoring of underrepresented scholars in the biobehavioral and health sciences is vital for the future of scientific inquiry, as well as for clinical and public health applications. Through the mentoring process, both the mentee and mentor can benefit by broadening their knowledge, skills, and perspectives relative to the professional goals and interests of the mentee. Establishing a trusting and nurturing relationship allows the mentor and mentee to identify short- and long-term goals, accompanied by strategies designed to maximize the mentee's success. Many relationships benefit from establishing explicit working guidelines early on, with recognition that flexibility may be necessary as the relationship matures. Adapting to the specific needs and challenges facing underrepresented doctoral trainees and early career scholars, we propose an integrative developmental framework informed by 3 fundamental assumptions: (a) the mentee's professional growth and personal development are intertwined; (b) the mentee's goals will evolve and sometimes change over time; and (c) reflective analysis of the distinctive skill sets, life experiences, and limits of the mentor and mentee will help strengthen the mentoring plan. A challenging issue in mentoring is how to individualize the approach for each mentee, recognizing the need to balance mentor support and advice with opportunities for mentee independence, self-appraisal, and creativity. We share our developmental framework with the hope that others may adapt this as a practical template to develop a joint plan amenable to intermittent monitoring to optimize productivity and personally rewarding professional career trajectories for an increasingly diverse workforce. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Barriers to HIV Testing: Patient and Provider Perspectives in the Deep South.

Although CDC guidelines call for universal, "opt-out" HIV testing, barriers to testing continue to exist throughout the United States, with the rural South particularly vulnerable to both HIV infection and decreased awareness of status. Therefore, the objectives of this study were to evaluate uptake of "opt-out" HIV testing and barriers to testing within the primary care setting in the South. A concurrent triangulation design guided the collection of quantitative data from patients (N = 250) and qualitative data from providers (N = 10) across three primary health clinics in Alabama. We found that 30% of patients had never been tested for HIV, with the highest ranked barrier among patients being perceived costs, access to specialty care, and not feeling at risk. Significant differences existed in perceived barriers between patients and providers. Increased provider-patient engagement and the routine implementation of "opt-out" HIV testing would effectively reveal and mitigate barriers to testing, thus, increasing awareness of status.

Universal Screening for HIV and Hepatitis C Infection: A Community-Based Pilot Project.

INTRODUCTION: Black men in the Deep South have been disproportionally affected by high HIV and hepatitis C virus infection rates. Conventional clinic-based screening approaches have had limited success in reaching those with undiagnosed HIV or hepatitis C virus infection. The purpose of this study was to evaluate the acceptability, feasibility, and best practices of an integrated HIV and hepatitis C virus community-based health screening approach. METHODS: The study used a mixed methods approach: focus group discussion, individual interviews, and surveys that assessed perceptions, perspectives, and HIV and hepatitis C virus awareness among six communities across Alabama and Mississippi. Data were collected and analyzed in 2014-2017. RESULTS: Although HIV and hepatitis C virus knowledge was limited among community members surveyed, the results of this study suggest that (1) using an integrated, community-based HIV and hepatitis C virus testing approach is acceptable and feasible; (2) formation of a community advisory board is a key element of successful community mobilization; (3) education and training of community members on disease-specific topics and overcoming stigma are essential; and (4) focus on and inclusion of young community members will be critical for the sustainability of screening efforts. CONCLUSIONS: Including and engaging communities at risk for HIV and hepatitis C virus infection in prevention research is a promising strategy to overcome existing barriers of stigma and discrimination. Integration of HIV and hepatitis C virus testing in universal health screening efforts utilizing a Community Health Advisors model encourages unbiased communication with a focus on overall community health. Community health advisors are recognized as important agents in this effort. SUPPLEMENT INFORMATION: This article is part of a supplement entitled African American Men's Health: Research, Practice, and Policy Implications, which is sponsored by the National Institutes of Health.

Chronic Stress and C-Reactive Protein in Mothers During the First Postpartum Year.

OBJECTIVE: Elevated levels of C-reactive protein (CRP) are associated with increased risk of cardiovascular and metabolic disease. The current study tested associations between psychosocial stress and CRP in a large sample of women during the first postpartum year. METHODS: We analyzed data collected by the five-site Community Child Health Network study, which studied a predominately poor population. Participants (n = 1206 women; 54% African American, 23% white, 23% Hispanic/Latina) were recruited shortly after the birth of a child. Multiple linear regression analyses tested associations of psychosocial stress in several life domains (financial, neighborhood, family, coparenting, partner relationship, discrimination, and interpersonal violence) with log-transformed CRP concentrations at 6-month and 1-year postpartum. RESULTS: Forty-eight percent of participants showed evidence of elevated CRP (≥3 mg/L) at 6-month postpartum, and 46% had elevated CRP at 12-month postpartum. Chronic financial stress at 1-month postpartum predicted higher levels of CRP at 6- (b = .15, SE = .05, p = .006) and 12-month postpartum (b = .15, SE = .06, p = .007) adjusting for race/ethnicity, income, education, parity, health behaviors, and chronic health conditions, though associations became nonsignificant when adjusted for body mass index. CONCLUSIONS: In this low-income and ethnic/racially diverse sample of women, higher financial stress at 1-month postbirth predicted higher CRP. Study findings suggest that perceived financial stress stemming from socioeconomic disadvantage may be a particular deleterious form of stress affecting maternal biology during the year after the birth of a child.

Risk, resilience, and depressive symptoms in low-income African American fathers.

OBJECTIVE: Parental depression influences family health but research on low-income African American fathers is limited. The primary goal of the present study was to examine the role of paternal risk factors and resilience resources in predicting depressive symptoms in the year after birth of a child in a sample of African American fathers. We hypothesized that paternal risk factors (low socioeconomic status [SES], perceived stress, negative life events, racism, avoidant coping style) and resources (social support, self-esteem, collective efficacy, approach-oriented coping style) would predict depressive symptoms in fathers at 1 year postbirth controlling for depressive symptoms at 1 month postbirth. METHOD: African American fathers (n = 296) of predominantly low SES from 5 U.S. regions were interviewed at 1 and 12 months after birth of a child regarding potential risk factors, resilience resources, and depressive symptoms. RESULTS: Depressive symptoms were low on average. However, hierarchical linear regression analyses revealed that avoidant coping style and experiences of racism predicted more depressive symptoms in fathers nearly a year after the birth of a child controlling for symptoms at 1 month. CONCLUSIONS: How fathers cope with stress and common everyday experiences of racism contributed to depressive symptoms in the year following birth of a child. Interventions that target race-related stressors and decrease avoidant coping may promote better outcomes in this important and understudied population. (PsycINFO Database Record

Issues and Solutions for Collecting Biological Specimen in Longitudinal Studies: Experience from the Community Child Health Network Research Network.

The inclusion of biomarkers in studies of stress and health outcomes is of growing interest, including for community-based participatory research (CBPR) studies. Yet the perspectives of participants and communities have been infrequently consulted to inform the biomarker collection process. The objective of this paper is to describe the process and outcomes of using CBPR in framing biomarker collection in a study of allostatic load in a maternal and child health population. Through analysis of focus group data, we identify aspects of CBPR that facilitate increased community trust and endorsement related to collecting biological samples, and also provide a community perspective that is often overlooked in the literature. We found that a CBPR approach facilitated greater understanding among community members about the importance of biomarkers, while simultaneously informing the design of a biomarker data collection protocol that was responsive to the desired scope and data collection procedures that reflected community priorities.

The Community Child Health Network Life Stress Interview: a brief chronic stress measure for community health research.

BACKGROUND AND OBJECTIVES: Chronic stress is implicated in many theories as a contributor to a wide range of physical and mental health problems. The current study describes the development of a chronic stress measure that was based on the UCLA Life Stress Interview (LSI) and adapted in collaboration with community partners for use in a large community health study of low-income, ethnically diverse parents of infants in the USA (Community Child Health Network [CCHN]). We describe the instrument, its purpose and adaptations, implementation, and results of a reliability study in a subsample of the larger study cohort. DESIGN AND METHODS: Interviews with 272 mothers were included in the present study. Chronic stress was assessed using the CCHN LSI, an instrument designed for administration by trained community interviewers to assess four domains of chronic stress, each rated by interviewers. RESULTS: Significant correlations ranging from small to moderate in size between chronic stress scores on this measure, other measures of stress, biomarkers of allostatic load, and mental health provide initial evidence of construct and concurrent validity. Reliability data for interviewer ratings are also provided. CONCLUSIONS: This relatively brief interview (15 minutes) is available for use and may be a valuable tool for researchers seeking to measure chronic stress reliably and validly in future studies with time constraints.