Ross Shegog - US grants

DESCRIPTION (provided by applicant): Web-Based Middle School HIV Prevention Curricula: Aspiring for Reach &Impact Early adolescent sexual behavior is a significant public health problem in the U.S. Few programs, however, have proven effective in delaying sexual behavior among middle school students, and many have limited potential for wide-scale dissemination. This investigative team has developed and evaluated a new HIV, STI and pregnancy prevention classroom and computer-based program, entitled It's Your Game...Keep it Real (IYG). We found IYG to be effective in delaying sexual initiation among youth after long term follow-up. This evaluation was based on student's participation in both the classroom and computer-based components. To increase its dissemination potential, determining the relative long-term effectiveness of the computer-based component as a standalone curriculum has become an important next step in the field, as this examines additional avenues for prevention. We recently converted all of the IYG computer activities to an Internet-based platform. An Internet version of the IYG computer-based component incorporates technological advances and the appeal of the Internet for youth, which may have the potential to bolster effects, improve lesson fidelity, and facilitate dissemination in a cost-effective manner. In a small pilot study of this Internet program, students exposed to the program were more likely to report positive effects on psychosocial factors related to risky sexual behavior. These findings need to be replicated in a larger trial;thus, this 3-year study proposes to evaluate this Internet-based HIV, sexually transmitted infection (STI), and pregnancy prevention curriculum as a standalone intervention for middle school students in a large urban school district. A randomized two-arm nested design will be conducted with 1,600 middle school students where schools receiving the Internet-based curriculum (n=7 schools) will be compared with comparison schools receiving usual care (n=7). This study builds on extensive prior research in this domain and will contribute to our understanding of using the Internet to deliver an HIV, STI, and pregnancy prevention program to middle school students. PUBLIC HEALTH RELEVANCE: Narrative Description The use of computers, games, and the Internet to address adolescent sex education is a burgeoning research area. An Internet-based HIV, STI, and pregnancy prevention program for middle school students has the potential for low-cost, high fidelity dissemination, if it is proven to be effective at delaying sexual initiation.

DESCRIPTION (provided by applicant): The goal of this 3 year Fast-Track STTR is to develop and evaluate a home-based intervention ('it's Your Game- Family') to provide age-appropriate sexual health life skills education and training for children (11-14 years) and to enhance parents' skills and self-confidence in support of this training. IYG-Family (IYG-F) will be an on-line game- based program and resource available to help parents and their children go beyond the sex talk to engage in an ongoing, developmentally appropriate, pregnancy, sexually transmitted infection (STI), and human immunodeficiency virus (HIV) prevention education experience. The study comprises 2 phases and 10 specific aims: Phase 1: Develop the theoretically- and empirically-based IYG-Family (IYG-F) prototype and conduct usability and feasibility testing (Months 1-12). Phase 1 Specific Aims: 1.1 Conduct focus groups, acceptability tests with our Parent-Youth Advisory Group (P-YAG) and literature review to inform IYG-F design; 1.2 Develop IYG-F design documents and program the prototype; 1.3 Test the IYG-F prototype functions and content (alpha test), and usability; 1.4 Evaluate (pilot-test) the IYG-F prototype fo feasibility and perceived value in the home setting; 1.5 Disseminate Phase 1 findings: Phase 1 report and peer reviewed publications. Phase 2: Develop IYG-Family informed from Phase 1 data and conduct a RCT to evaluate the impact of IYG-F (Months 13-36). Phase 2 Specific Aims: 2.1 Revise IYG-F design documents (based on Phase 1 data) and obtain P-YAG sign-off; 2.2 Develop the full IYG-F program; 2.3 Test the IYG-F prototype functions and content (alpha test), and usability; 2.4 Conduct a randomized controlled trial of IYG-F in 80 homes to test the 4 primary hypotheses (below); 2.5 Disseminate Phase 2 findings: Phase 2 report and peer reviewed publications. The 4 primary hypotheses are 1. Compared to those not receiving IYG-F, youth who access IYG-F will demonstrate significantly greater intentions to abstain from initiation of sexual behavior. 2. Compared to those not receiving IYG-F, youth who access IYG-F will demonstrate significantly improved psychosocial determinants of sexual behavior (including knowledge, increased self-efficacy for refusing sexual activity; less permissive beliefs and perceived norms). 3. Compared to parents not accessing IYG-F, parents who access IYG-F will report significantly improved psychosocial determinants (including knowledge, attitudes, and self-efficacy) regarding parent-child sexual health communication and parental monitoring and less permissive beliefs related to youth sexual behavior. 4. Compared to youth and parents not receiving IYG-F, youth and parents who access IYG-F will report increased communication about sexual health, increased parental monitoring, increased parent-child connectedness, and improved parenting ratings. This project is founded on previous studies by this experienced collaborative investigative team on developing and testing a successful middle school pregnancy, STI, and HIV prevention program, It's Your Game...Keep it Real, (IYG) that addresses knowledge, attitudes, perceived norms, refusal, and communication skills related to healthy relationships, dating, and sex. Results from two randomized controlled trials conducted in Texas middle schools indicate positive psychosocial outcomes after 7th and 8th grade interventions, and significant, sustained behavioral outcomes to 9th grade. IYG-Family will include the successful skill building components of this curriculum but will be developed to also focus on parent-child communication and connectedness regarding sexual health in the home environment. IYG-Family is significant because it addresses the gap between the needs of families in preparing their sexually maturing youth and the developmentally appropriate intervention resources currently available to support them. It addresses the broader public health concerns of adolescent pregnancy, and STI and HIV infection. IYG-Family is innovative in providing a unique home-based resource for a challenge faced by every family with sexually maturing youth. In addition to providing developmentally appropriate sexual health education for the middle school child IYG-Family is positioned to contribute a solution for the discomfort and uncertainty of parents who lack confidence or skills to adequately provide effective information and skills training to help their child make healthy and responsible decisions about healthy friendships, dating relationships, and sex. It contributes a solution that is cost-effective, of hih-fidelity, and readily accessible. PUBLIC HEALTH RELEVANCE: Despite steady decline in the United States over the past decade, adolescent births and sexually transmitted infections (STIs) remain serious public health issues. Teen pregnancy costs US taxpayers over $9 billion.4 One in four females (14-19 years) are infected with an STI5 and youth (15- 24 years) account for 9.1 million (48%) of all new STI cases, 6 with estimated medical costs of $6.5 billion.7 This study will contribute to our understanding of using the Internet to deliver an HIV/STI and pregnancy prevention program to middle school-aged students in home and mediated by parent involvement.

PROJECT SUMMARY Given the growing diversity of populations in the United States, communicating effectively is a key element of sexual health promotion to teens in communities where disparities exist, particularly among African American, Hispanic/Latino, American Indian/Alaska Native (AI/AN), and sexual and gender minority (SGM) youth. Disparities in sexual health outcomes suggest that these subgroups may not be receiving sufficient health information, or that messages are not perceived as relevant or understandable, impeding healthy decision-making. Understanding common and unique aspects of values, beliefs, and language should allow the crafting of messages, strategies, and steps to improve communication and contextualize sexual health promotion messages at individual and community levels. Our research will determine the preferred messages, messengers, and communication channels relevant to teens for the specific topics of abstinence, consistent and correct use of condoms, and STI/HIV testing. In response to the requested objectives in SIP 17-006, our research aims are to: (1) Conduct a literature review of barriers, facilitators, and current STI/HIV and pregnancy prevention messages and messaging channels for adolescents by race/ethnicity, sexual orientation and gender identity; (2) Conduct focus groups/interviews with African American, Hispanic/Latino, AI/AN, and SGM youth on messages, sources, and channels; (3) Conduct a Delphi survey of experts to achieve consensus on the findings of the literature review and focus groups; and (4) Conduct a second round of focus groups with a larger and broader sample of youth, to revise and finalize specific theory- and evidence-based recommendations for sexual health messaging to that meets the diversity of the adolescent population. Combining our understanding from youth (the constituent stakeholders) with input from topical experts will ensure the development of a set of recommendations that are both practical and based on evidence for acceptability and efficacy. The ultimate product will be a library of messages and strategies (including written, printed and oral sexual health messages), as well as messages delivered via mass media and multimedia technologies, organized by middle and high school age, gender, race/ethnicity, and sexual orientation and gender identity. Our approach builds upon existing collaborations and access to diverse communities, and our extensive experience as a team in adolescent sexual health promotion. It is innovative because it not only seeks to identify effective messaging in sexual health promotion, but also cultural factors influencing effectiveness.

ABSTRACT The goal of this 3 year Fast-Track STTR is to develop and evaluate a multi-level (youth, parent, school) Internet-based dating violence (DV) prevention program, ?Me & You-Tech? (MYT) for 6th--grade middle school students. By 6th grade, approximately 50% of students will have engaged in a dating relationship. Of these, almost one-third will have perpetrated physical DV and almost two-thirds will have perpetrated emotional DV. Youth exposed to DV are more likely to perform poorly in school, experience difficulties in future relationships, participate in adult violence, and experience depression, suicidal ideation, bullying, substance use, and risky sexual behavior. Many U.S. states are required by law to provide DV education. However, youth exposure to DV education, in particular, effective programs, is minimal and the few programs available are confronted with challenges of school-based barriers to fidelity, training, and resources. The study comprises 2 phases and 10 specific aims: Phase 1: Develop the theoretically- and empirically- based MYT prototype and test feasibility (Mos.1-12). Phase 1 Specific Aims: 1.1 Conduct a content analysis of existing Me & You and SSS intervention matrices to identify required core content, methods, and strategies for MYT design (youth-, parent-, and school-level components); 1.2 Conduct review of MYT concepts and wireframes to test acceptability and perceived feasibility for use in the context of the school by School, Youth, and Parent Advisory Groups to inform MYT design (youth, parent-, and school-level components); 1.3 Develop MYT design documents and develop the prototype including alpha testing; 1.4 Test usability of MYT prototype; 1.5 Evaluate (pilot-test) the MYT prototype for feasibility and perceived value in school and home settings and review with distribution collaborator (ETR Inc.) for optimal specifications for dissemination; 1.6 Disseminate Phase 1 findings (Phase 1 report and peer reviewed publications). Phase 2: Develop MYT informed from Phase 1 and conduct a RCT to evaluate impact of MYT (Mos. 13-36). Phase 2 Specific Aims: 2.1 Revise MYT design documents (based on Phase 1 data) and obtain advisory group sign-off; 2.2 Develop the full theoretically- and empirically-based MYT program; 2.3 Test full MYT program functionality and content (alpha test), and usability; 2.4 Conduct a RCT of MYT 6th- grade students (n=300) in 4 Houston middle schools; 2.5 Review MYT distribution plans with collaborator ETR Inc.; 2.6 Disseminate Phase 2 findings of Phase 2 report and peer reviewed publications. The 3 primary hypotheses are: Compared to those not receiving MYT, youth who access MYT will demonstrate significantly: 1. Reduced DV (emotional, physical, or sexual) perpetration; 2. Reduced DV (emotional, physical, or sexual) victimization; and 3. Improved psychosocial determinants related to healthy/unhealthy dating relationships (e.g., knowledge, skills, self-efficacy, attitudes and norms, gender role beliefs, perceived parental and school factors). MYT addresses a call for innovative theory-based programs that use a social-ecological approach to DV, involving youth, their family, and their school while leveraging internet-based channels to optimize program fidelity and minimizing training, resources, and costs that limit adoption and scale-up in school settings. This project is founded on previous RCTs by this experienced collaborative investigative team on developing and testing successful middle school multi-component interventions. Me & You?Building Healthy Relationships (Me & You), a DV curriculum comprising classroom and computer-based lessons for youth, parental-child home-based activities, and school staff trainings, resulted in reduced DV perpetration and positive psychosocial outcomes related to norms towards violence, attitudes towards sexting, conflict resolution skills. The Secret of Seven Stones (SSS), an Internet-based pregnancy prevention game for parents and youth resulted in enhanced parent-youth communication regarding healthy relationships through text-based behavioral cues. Based on this strong empirical precedent, a completely Internet-based version of Me & You is proposed that leverages the strengths of these school- and home-based approaches. The specific aims of this study are to: MYT is significant because it addresses an important public health challenge to build youth skills for respectful dating relationships void of violence, to train school staff in providing supportive and protective environments to achieve this, and to enhance parent-youth discussion to reinforce the importance of healthy relationships. MYT is innovative because it will provide evidence in using an integrated multi-component socio-ecological approach to enhancing healthy relationships that uses a scalable technology-based channel to overcome the barriers of fidelity, resources, and cost of dissemination in school settings and provides a scalable solution to what is a dearth of readily disseminated evidence-based TDV programs and will provide.

Native iCHAMPS: An Innovative Online Decision Support System for Increasing Implementation of Effective Sexual Health Education in Tribal Communities ABSTRACT American Indian and Alaska Native (AIAN) youth experience serious disparities in sexual and reproductive health. These disparities may be ameliorated by the implementation of effective sexual health education. Yet, multiple factors, such as lack of access to culturally-relevant evidence-based interventions (EBIs), limited trained personnel, cultural barriers, and geographic isolation, hinder the adoption and implementation of effective sexual health EBIs in tribal communities. The goal of this R21 study is to adapt and assess the feasibility of an innovative online decision support system (DSS), Native iCHAMPS, as an effective implementation strategy to facilitate the adoption and implementation of sexual health EBIs in AIAN communities. We propose to adapt iCHAMPSS (CHoosing And Maintaining Effective Programs for Sex Education in Schools), a theory-based, online DSS developed by our research team to increase uptake and implementation of sexual health EBIs in Texas schools. Grounded in dissemination and implementation (D&I) theories, iCHAMPSS comprises 60+ tools to provide step-by-step guidance to overcome D&I barriers for sexual health education. Shown to impact critical determinants of EBI adoption and implementation and to mobilize school personnel to obtain board approval and implement a sexual health EBI, iCHAMPSS serves as an excellent implementation strategy to adapt for AIAN communities. AIAN stakeholders (n=35) rated iCHAMPSS as acceptable, easy to use, credible, appealing, and more helpful than current resources for EBI adoption and implementation in AIAN communities. Yet, because iCHAMPSS was designed specifically for Texas schools, the underlying DI& processes may not adequately reflect D&I processes in AIAN communities. Indeed, AIAN stakeholders recommended adaptations to iCHAMPSS to better reflect the needs and values of tribal communities. Our long-term goal is to reduce teen pregnancy, STI/HIV among AIAN youth by increasing the adoption, implementation, and maintenance of culturally-relevant sexual health EBIs in AIAN communities. In this R21 study, we propose to adapt the existing iCHAMPSS conceptual model and DSS to address barriers and facilitators to the adoption, implementation, and maintenance of sexual health education EBIs in AIAN communities (Native iCHAMPS), identify strategies to optimize its adoption and implementation, and assess the feasibility and impact of adopting and implementing Native iCHAMPS among a sample of heterogeneous and geographically disparate AIAN stakeholders (n=45) across the U.S. The study is innovative as it informs a culturally relevant, conceptual D&I model for sexual health EBIs in AIAN communities, and translates that model as a practical cross-platform digital DSS (Native iCHAMPS) to increase D&I capacity in geographically isolated, low-resource AIAN communities. It is significant because it advances use of culturally-relevant sexual health EBIs, thus impacting population health for underserved, high-risk AIAN youth. Findings will inform a randomized multisite R01 trial to assess the effectiveness of Native iCHAMPS in AIAN communities.