Clinic Staff Perceptions of Implementing a Sexual and Reproductive Health Entertainment-Education Program for Young Women of Color.

Objective: Entertainment-education interventions remain underutilized in sexual and reproductive health (SRH) despite evidence that they can be effective and place a low burden on staff. This study explores perceived facilitators and barriers for implementing an entertainment-education video intervention for 18- to 19-year-old African American and Latina women in SRH clinics. Design: Cross-sectional online survey (n=100) and telephone interviews (n=19) were completed May through August 2018. Setting: SRH clinics were located across 32 US states and 1 Canadian province. Participants: SRH clinic staff were diverse in type of clinic, role, and geography and were recruited using purposive sampling. Methods: Bivariate analyses were used for quantitative data, and thematic analysis was used for qualitative data. Main Outcome Measures: Intervention acceptability, perceived feasibility, and likely uptake were assessed using agreement statements (survey) and open-ended questions (interviews and survey). Results: Interviewed clinic staff described the intervention as engaging, educational, and promising for improving client SRH knowledge and behaviors. Nearly all (95%) survey respondents said showing the video would be feasible. Most (56%) indicated likely uptake, which was significantly associated with perceived feasibility (P=.000), acceptability (P≤.001), and working at a public health clinic (P=.023). Implementation barriers included the video's potential relevance to only certain clients and the need for additional information or staff and/or management buy-in. Conclusions: This is the first study to assess perceived implementation facilitators and barriers of an entertainment-education video intervention among SRH clinic staff. The intervention was well received, with certain barriers potentially alleviated by offering information about entertainment-education and multiple implementation methods. These findings can help improve dissemination efforts for video-based entertainment-education interventions in clinics serving young women of color.

Development, acceptability, and perceived effectiveness of a trauma-informed adolescent self-regulation intervention.

Youth who have experienced trauma often face challenges with self-regulation and can have diminished health outcomes, including those related to sexual and reproductive health. We developed a 12-session blended e-learning intervention for youth involved in juvenile justice systems to encourage healthy sexual decision-making by improving self-regulation skills. This paper describes the development of the program, e-Practice Self-Regulation, as well as an assessment of program acceptability and perceived effectiveness among youth participants. Data were collected using a feedback survey from youth who both completed (n = 95) and did not complete (n = 80) the intervention. Program acceptability was high among all participants, and over 70 % of both completers and non-completers would recommend e-Practice Self-Regulation to peers. Youth reported positive interactions with facilitators and described sessions as helpful, interesting, and educational. The most common criticism was online session length. A majority in both groups reported perceived effectiveness related to sexual health and self-regulation, which increased with more sessions completed. Results suggest e-Practice Self-Regulation is acceptable to youth participants, who reported learning skills necessary for self-regulation and sexual health and intended to use these skills to avoid unplanned pregnancy.

Overcome the Fear (Vencer el Miedo): using entertainment education to impact adolescent sexual and reproductive health and parent-child communication in Mexico.

BACKGROUND: Adolescents in Mexico experience high pregnancy and birth rates. A collaboration with Grupo Televisa led to the development of an entertainment-education telenovela intervention, Overcome the Fear (OTF), which aired in 2020 to a national audience and addressed adolescent sexual and reproductive health (SRH) topics. This study details the development and evaluation of OTF's impact on adolescent contraceptive practices and parent-adolescent SRH communication in Mexico. METHODS: We conducted cross-sectional survey interviews (street-intercept and telephone) with 12-19-year-olds (n = 1640) and parents of adolescent children (n = 820) post-broadcast across Mexico's five most-populated metropolitan zones. Quotas were implemented for gender, zone, and OTF viewership (viewer vs. non-viewer). Bivariate statistics and multivariable binary logistic regression models assessed the relationship between OTF viewership (including parent-adolescent co-viewing) and adolescent contraceptive practices and parent-adolescent SRH communication. Adolescent and parent data are not dyadic and were analyzed separately. RESULTS: Nearly half of adolescents (47.9%) and parents (47.7%) were viewers. Among adolescents, bivariate analyses suggest that viewers had less negative attitudes towards contraception (p < .001). Logistic regression models suggest that adolescent viewers were more likely to seek out information about contraception (p < .001) and unhealthy romantic relationships (p = .019), and to use contraception other than condoms (p = .027) and dual contraception (p = .042) in the last 3 months. Among parents, bivariate analyses suggest that non-viewers had more positive attitudes towards abstinence (p = .045) and more negative attitudes towards contraception and communication with adolescents about sex (p = .001). Logistic regression models suggest that parent viewers were more likely to have talked with adolescent children about sexual relations (p < .001), contraceptive methods (p = .01), condoms (p = .002), and abstinence (p = .002) in the last 3 months. Parent-adolescent co-viewing of OTF was also significantly related to certain outcomes in bivariate analyses. CONCLUSIONS: This study suggests that viewership of a high-quality entertainment-education telenovela informed by extensive formative research is related to adolescent health outcomes and to parent-adolescent SRH communication on a country-wide scale in Mexico. Entertainment-education remains an underutilized public health strategy, despite its promise to engage viewers and motivate healthful behaviors.

Development and evaluation of a social marketing campaign to address methamphetamine use in Los Angeles County.

BACKGROUND: This study describes the development and impact of a social marketing campaign in early 2020 intended to prevent and reduce methamphetamine use in Los Angeles County (LAC). We used social marketing principles and the transtheoretical model to design the campaign, which was intended to avoid stigmatization of methamphetamine users and communicate compassion, empathy, and support. METHODS: To evaluate its impact, we collected cross-sectional online survey data post-campaign (n = 1,873) from LAC residents in population segments considered higher risk for methamphetamine use. We examine associations between campaign exposure and outcomes using bivariate analyses and binary logistic regression models, which control for the impact of the COVID-19 pandemic on methamphetamine use or likelihood of use. RESULTS: The analyses revealed that campaign exposure was associated with having more negative attitudes toward methamphetamine, calling LAC's substance abuse service helpline, using methamphetamine fewer days, and considering abstaining. Frequency of exposure to campaign advertisements was positively associated with calling the helpline, suggesting a campaign dose effect. COVID-19-related factors were associated with using methamphetamine in the past 30 days. CONCLUSIONS: Social marketing campaigns hold promise for impacting methamphetamine prevention and cessation behaviors. This study adds to the limited literature on mass marketing interventions to address this major health issue.

Integrated Multicultural Media Campaign to Increase COVID-19 Education and Vaccination Among Californians, 2021.

Despite the availability of safe, effective COVID-19 vaccines, many remain unvaccinated or partially vaccinated. In 2021, the California Department of Public Health launched a California-wide integrated multicultural vaccine media campaign. The campaign was evaluated in two waves through online surveys with adults (n = 1594; n = 1575). Campaign exposure was associated with looking for vaccine information, visiting a state vaccine Web site, and becoming fully vaccinated during the campaign. Higher campaign exposure was associated with greater odds of vaccine engagement. (Am J Public Health. 2022;112(10):1389-1393. https://doi.org/10.2105/AJPH.2022.306974).

"Food is something everyone should participate in": A positive deviance approach to understanding the use of a food and nutrition app in low-income, Latino homes.

OBJECTIVES: Latino families are among the most likely to be overweight or obese, which are conditions associated with numerous health risks and diseases. These families might lack know-how for preparing vegetables that fall outside cooks' culinary comfort zones and cultural traditions. Mobile apps are increasingly being developed for healthier cooking and eating, but research has not much explored how such apps are used among these families to help facilitate changes in eating patterns. This research seeks to identify behaviors and motivations that lead household cooks (i.e. mothers) in low-income Latino homes to use a food and nutrition app and create healthier eating environments for their families. METHODS: This study uses a positive deviance approach and individual interviews with mothers who were frequent app users and experienced beneficial food outcomes during their participation in a randomized controlled trial that tested the effects of an app on their cooking and family eating behaviors. Interviews were analyzed for themes using a framework analysis approach. RESULTS: Three themes emerged across interviews that were suggestive of approaches that led mothers to become frequent app users and prepare healthier meals: (1) mothers invited their children to use the app; (2) they involved both sons and daughters in the kitchen; and (3) they (cautiously) stepped outside their culinary comfort zones. CONCLUSION: Mobile apps and app-focused interventions should include features that invite: app co-use between mothers and children; opportunities for mothers to socialize boys, as well as girls into kitchen routines; and the use of culturally-familiar ingredients or recipes that are easily adaptable.

Mobile app increases vegetable-based preparations by low-income household cooks: a randomized controlled trial.

OBJECTIVE: We built an app to help clients of food pantries. The app offers vegetable-based recipes, food tips and no-cost strategies for making mealtimes healthier and for bargain-conscious grocery shopping, among other themes. Users customize materials to meet their own preferences. The app, available in English and Spanish, has been tested in a randomized field trial. DESIGN: A randomized controlled trial with repeated measures across 10 weeks. SETTING: Clients of fifteen community food pantry distributions in Los Angeles County, USA.ParticipantsDistributions were randomized to control and experimental conditions, and 289 household cooks and one of their 9-14-year-old children were enrolled as participants. Experimental dyads were given a smartphone with our app and a phone use-plan, then trained to use the app. 'Test vegetables' were added to the foods that both control and experimental participants received at their pantries. RESULTS: After 3-4 weeks of additional 'test vegetables', cooks at experimental pantries had made 38 % more preparations with these items than control cooks (P = 0·03). Ten weeks following baseline, experimental pantries also scored greater gains in using a wider assortment of vegetables than control pantries (P = 0·003). Use of the app increased between mid-experiment and final measurement (P = 0·0001). CONCLUSIONS: The app appears to encourage household cooks to try new preparation methods and widen their incorporation of vegetables into family diets. Further research is needed to identify specific app features that contributed most to outcomes and to test ways in which to disseminate the app widely.