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Background Sexually exploited youth are disconnected from societal tethers and need support systems, which makes them some of the most vulnerable of youth. This heightened level of vulnerability increases their risk for violence, abuse, ongoing sexual exploitation and all its sequelae. The purpose of this study was to examine an evidence-based intervention called STRIVE (support to reunite, involve and value each other) that has been a successful family re-engagement strategy with newly homeless youth. We sought to explore its contextual relevance for youth with risk factors for sexual exploitation and identify necessary adaptations to reduce risk factors for sexual exploitation. We deliberately took an intersectional approach in conducting this study. Methods Six community-based focus groups were conducted with youth at risk for sexual exploitation and their service providers. Each group was recorded, transcribed, coded, and thematically analyzed. Results Results from 29 youth and 11 providers indicate that there are unique considerations that must be taken into account while working with youth at risk for sexual exploitation to ensure effective service delivery and/or ethical research. Emergent themes included: setting the stage by building rapport and acknowledging experiences of structural violence, protect and hold which balances youth’s need for advocacy/support with their caregivers’ need for validation/understanding, and walking the safety tightrope by assessing risks and safety planning. Discussion Focus groups are an effective methodology when working with traditionally disempowered populations particularly in gaining a range of perspectives to meet unique needs/preferences. Youth at risk for commercial sexual exploitation needs require strengths-based, individualized, multi-systemic approaches.

Pediatric and adolescent firearm injuries and fatalities in the United States have surged to levels not seen since the mid-1990s, marking a critical public health inflection point. Young Black males (ages 15-24) experience firearm-related fatality rates 24 times higher than their White peers. Despite this disproportionate risk, they are less likely to participate in traditional firearm violence prevention programs. This disparity highlights the urgent need for innovative, culturally responsive approaches that address the emotional, behavioral, and social determinants of violence. This pilot study aims to evaluate the preliminary effects of BrotherlyACT, a culturally responsive, trauma-informed, multicomponent mobile and web-based intervention designed to support young Black males (ages 15-24) in navigating and preventing community violence, substance use, and mental health challenges. The intervention aims to increase access to precrisis support and mental health resources for youth living in low-resource, high-violence settings. Seventy young Black males with Serious Fighting, Friend Weapon Carrying, Community Environment, and Firearm Threats (SaFETy) scores between 1 and 5 (indicating low-to-moderate firearm violence risk) were enrolled in this prospective pretest-posttest study. Participants completed a psychoeducational component of the BrotherlyACT intervention, consisting of 7 video-based modules. Surveys were administered at baseline and again 4 weeks later to assess changes in attitudes toward guns and violence (Attitudes Toward Guns and Violence Questionnaire), reactive and proactive aggression (Reactive-Proactive Aggression Questionnaire), psychological distress (Kessler Psychological Distress Scale), and depressive symptoms (8-item Patient Health Questionnaire). Paired t tests were conducted to analyze pre-post differences. A total of 70 young Black males (mean age 20.97 years, SD 2.44 years) participated in the study. Nearly half reported recent physical fights (48/70, 69%), gun threats (39/70, 56%), or hearing gunshots in their neighborhood (63/70, 90%). More than 50% (39/70, 56%) reported illicit drug use, and 32 out of 70 (46%) reported substance-related violence. SaFETy scores revealed heterogeneous but elevated exposure to firearm risk factors, particularly in community violence and firearm threats. Postintervention, participants demonstrated a statistically significant reduction in attitudes toward guns and violence (Attitudes Toward Guns and Violence Questionnaire; mean 29.8-26.1, P<.001, d=0.53), with the largest shift observed in \"Aggressive Response to Shame\" (28% reduction). Reactive aggression significantly declined (mean 10.48-8.67, P=.008, d=0.37), whereas proactive aggression remained stable. Psychological distress and depressive symptoms remained stable. Nearly all participants (68/70, 97%) completed all modules in a single session, with 47 out of 70 (67%) finishing within an hour, suggesting high feasibility and user engagement. Preliminary findings indicate that BrotherlyACT may reduce proviolence attitudes and reactive aggression among young Black males. These results underscore the feasibility and potential impact of culturally responsive digital interventions as a strategy to prevent firearm violence among underserved youth populations.

Young Black male individuals are 24 times more likely to be impacted by firearm injuries and homicides but encounter significant barriers to care and service disengagement, even in program-rich cities across the United States, leaving them worryingly underserved. Existing community-based interventions focus on secondary and tertiary prevention after firearm violence has occurred and are typically deployed in emergency settings. To address these service and uptake issues, we developed BrotherlyACT-a nurse-led, culturally tailored, multicomponent app-to reduce the risk and effects of firearm injuries and homicides and to improve access to precrisis and mental health resources for young Black male individuals (aged 15-24 years) in low-resource and high-violence settings. Grounded in Acceptance and Commitment Therapy, the app provides life skills coaching, safety planning, artificial intelligence-powered talk therapy, and zip code-based service connections directly to young Black male individuals at risk for violence and substance use. The primary aim of this study is to evaluate the usability, engagement, and satisfaction of BrotherlyACT among target young Black male users and mobile health (mHealth) experts, using a combination of formative usability testing (UT) and heuristic evaluation (HE). Using a convergent mixed methods approach, we evaluated the BrotherlyACT app using HE by 8 mHealth specialists and conducted UT with 23 participants, comprising 15 young Black male users (aged 15-24 years), alongside 4 adult internal team testers and 4 high school students who were part of our youth advisory board. UT included the System Usability Scale and thematic analysis of think-aloud interviews and cognitive walkthroughs. HE involved mHealth experts applying the Nielsen severity rating scale (score 0-3, with 3 indicating a major issue). All testing was conducted via REDCap (Research Electronic Data Capture) and Zoom or in person. Qualitative usability issues were categorized into 8 thematic groups, revealing only minor usability concerns. The app achieved an average System Usability Scale score of 79, equivalent to an A-minus grade and placing it in the 85th percentile, indicating near-excellent usability. Similarly, the HE by testers identified minor and cosmetic usability issues, with a median severity score of 1 across various heuristics (on a scale of 0-3), indicating minimal impact on user experience. Overall, minor adjustments were recommended to enhance navigation, customization, and guidance for app users, while the app's visual and functional design was generally well received. BrotherlyACT was considered highly usable and acceptable. Testers in the UT stage gave the app a positive overall rating and emphasized that several key improvements were made. Findings from our UT prompted revisions to the app prototype. Moving forward, a pilot study with a pretest-posttest design will evaluate the app's efficacy in community health and emergency care settings. RR2-10.2196/43842.

Teens with socially complex needs-those who face multiple and potentially overlapping adversities-are disproportionately affected by several barriers to mental health screening and treatment. Pediatric primary care (PPC) is a typically low-stigmatized setting for teens that is visited at least annually. As such, implementing digital mental health tools (DMH), as low-intensity treatments in PPCs may increase the reach of such tools for teens with socially complex needs. This study aimed to evaluate the Teen Assess, Check, and Heal (TeACH) System in comparison to a control condition while integrated into PPCs at 2 Medical Centers serving teen patients in Chicago, Illinois. Through collaboration with key players throughout the design and implementation planning phases, the TeACH System is hypothesized to increase teen patient self-reported engagement with DMH and address specific individual-level barriers to mental health care, compared with a digital psychoeducation control condition. Eligible participants will be recruited through PPC clinics housed within the University of Illinois Chicago (UIC) and Rush University Medical Center (RUSH). Recruitment involves invitations from research staff members and primary care clinicians and staff members, as well as posting flyers with QR codes at the specified clinics. All participants complete a brief demographic survey, baseline survey, and Kiddie-Computerized Adaptive Tests Anxiety Module. Participants are randomized to receive either the control condition (digital evidence-based workbook) or the intervention (TeACH System Feedback and Resources). All randomized participants will then be invited to complete an immediate and 1-week follow-up survey. The primary outcomes assess changes in engagement with DMH (ie, likelihood to use DMH for anxiety and actual DMH use) and individual-level barriers to mental health care (ie, symptom understanding and confidence to act). Descriptive analyses will be conducted to characterize the sample and usability ratings of the TeACH System. Linear or generalized linear mixed effects regression models will examine differences in primary outcomes over time. Recruitment began in July 2024 and data collection is expected to be completed by August 2025. To date, 122 teens have assented to complete study activities, 80 have been randomized (an additional 24 teens have had subthreshold anxiety symptoms and were therefore not randomized), and 42 teens have completed the 1-week follow-up assessment. This study will provide preliminary feasibility data that may inform how the TeACH System and other DMH low-intensity treatments might better engage and support teens with socially complex needs. ClinicalTrials.gov NCT05466929; https://clinicaltrials.gov/study/NCT05466929. DERR1-10.2196/65245.

Rapid point of care tests for respiratory infections are associated with high rates of false negative results which can drive empiric, and potentially inappropriate, antibiotic use. Because infectious pathogens alter VOC composition, unique VOC signatures in biospecimens hold the potential to discriminate bacterial and viral infections from uninfected controls. One approach for rapid identification of respiratory pathogens is the electronic nose (e-nose), a sensor device that uses artificial intelligence to recognize disease-specific patterns in VOC profiles of gaseous mixtures. In this preclinical proof of concept study, we tested the validity of an e-nose to discriminate PCR-confirmed cases of infection with three viral pathogens (SARS-CoV-2, RSV, influenza A) from uninfected controls using nasopharyngeal test swab media. Using exploratory factor analysis, the e-nose discriminated both influenza A and SAR-CoV-2 from uninfected controls. To assess sensitivity and specificity, we applied factor analysis-based threshold values and obtained high levels of sensitivity (96.30%) and specificity (90.62%) for influenza A and more modest levels for SARS-CoV-2 (sensitivity=75%, specificity=68.57%). We did not apply threshold values to RSV samples because the e-nose sensors showed low discriminatory power for that pathogen. Our findings support proof of concept of the validity of the e-nose to discriminate common viral respiratory pathogens. Our use of binary thresholds for influenza A, which are easily adapted to point-of-care settings, yielded superior sensitivity results and comparable specificity results when compared to rapid tests. We recommend that future studies apply our analytic approach to samples of human breath to determine if these findings can be replicated or improved.

[This corrects the article DOI: 10.1371/journal.pone.0332399.].

Race-based health disparities for racially and ethnically diverse people with orthopedic-related conditions are well documented and their experiences when seeking care deserve more attention. The purpose of this study was to understand the lived experiences of racial microaggressions occurring when racially and ethnically diverse people seek health care services for orthopedic-related conditions. We used transcendental phenomenology to understand their lived experiences of racial microaggressions while receiving orthopedic-related health care services. All participants self-identified as Black, none as Hispanic. Nineteen final codes were organized into five patterns and then into five themes—two background and three figural themes. Background themes: discrimination can occur across a lifetime, and poor treatment of poor people fuels health inequity. Figural themes: racial discrimination can come at any time and in various forms; resistance is necessary in the face of racial discrimination; and despite discriminatory encounters, health care goals are achievable. Participants shared their lived experiences of racial microaggressions while seeking care for their orthopedic-related conditions ( figural ) through a lens shaped by their other past experiences with varied discrimination ( background ). Black individuals have a longstanding relationship with racial discrimination that has a negative impact on many aspects of their lives, including their health. The results highlight ways to promote equity by capitalizing on Black individuls’ goals to actively pursue health.

Data collected from pediatric primary care settings during the pandemic suggest an increase in internalizing symptoms and disparities in care based upon minoritized identity status(es). To inform care moving forward, the current study characterized the pandemic and related technology usage experiences of teenaged pediatric patients from communities with high hardship indexes. As part of a larger mixed-methods study, 17 teens (Mean age = 15.99 ± .99) and 10 caregivers independently voiced experiences related to the pandemic during remote focus group and interview sessions. Thematic analyses were used to assess qualitative data; descriptive analyses were used to characterize qualitative data. Despite no direct queries about the pandemic, 41% of teens and 40% of caregivers described their lived experiences during the pandemic. Two subthemes emerged within the primary theme of COVID-19: (1) Wellness/Mental Health and (2) Smartphone Use and Utility. Although distress and negative effects were voiced, questionnaire data indicated normative psychosocial functioning for both teen self-report and caregiver proxy report. Informed by the voiced experiences of teens and their caregivers from communities with high hardship indexes, methods for better assessing and managing internalizing symptoms in teen patients are presented. A multi-modal and multi-informant approach that leverages technology to garner information about teens’ experiences and deliver care may help improve the well-being of teens in communities systemically burdened with disparities.

This study’s objective was to assess which caring recruitment behaviors correlate with the successful recruitment of older African-American adults—a two-step cross-sectional design employing a vignette-based survey methodology. Kristen Swanson’s middle-range theory of caring was used to guide the examination of African-American adults’ (65 years of age and older) perceptions of research-study-recruiter recruitment behaviors. This study’s main findings are twofold: Step 1: Seven of ten invited experts identified major revisions of the two core vignettes, written at an eighth-grade reading level and high school comprehension. Step 2: A 51% response rate yielded findings that this methodology successfully captured older African-American adults’ perception of research study recruiters’ behavioral characteristics during the recruitment process. Older African-Americans who received the hypothetical caring vignette were twice as likely to indicate their willingness to enroll in a research study with a high commitment (i.e., brain donation) compared to their counterparts who received the hypothetical uncaring recruitment scenario. Vignette-based survey methodology holds promise as a tool for informing the recruitment of older African-American adults and other minorities into federally funded health-related research studies.

A significant proportion of African American (AA) fathers live in households apart from their young children. This living arrangement can have detrimental effects for children, families, and fathers. One hundred seventy-eight (n = 178) AA fathers, not residing with their 2–6-year-old children, were enrolled in a randomized trial to test the Building Bridges to Fatherhood (BBTF) program against a financial literacy comparison condition. BBTF is an intervention that was developed collaboratively with a fathers’ advisory council of AA fathers who oversaw all aspects of program development. Based upon advisory council feedback, short video scenes captured fathers interacting with their children, their children’s mothers, and other fathers. These video scenes were used to jump start the discussion around fatherhood, parenting, communication, and problem solving during the intervention group meetings. The actors in the video scenes were recruited from the community. Two trained group leaders, using a standardized group leader manual, delivered the intervention. The Money Smart Financial Literacy Program (MSFLP), which served as the comparator, was also delivered by AA men. Program satisfaction was high in both conditions. Even so recruitment and retention challenges influenced the ability to detect father and child outcomes. This study informs the participation of vulnerable urban AA fathers in community-based fatherhood intervention research and provides insight into bolstering engagement in studies focused on this population.