IntroductionIncreased cannabis use in young adults may influence brain health and neurodevelopment. In the context of chronic HIV-associated neuroinflammation, however, mild cannabis use may attenuate negative outcomes through anti-inflammatory effects. More frequent cannabis use may remain deleterious to both young adults with HIV (YWH) and without HIV (YWoH). We explored cross-sectional associations between cannabis use frequency and cognitive performance in YWH and YWoH.MethodParticipants aged 18–24 included 38 YWH and 61 YWoH (32% White) who completed cognitive tests of verbal memory, processing speed, working memory, executive functions, and overall fluid cognition. Timeline follow-back interviews assessed days of cannabis use (past 30, 180 and 365 days). Primary analyses focused on 30-day use, categorized as: no use, mild/moderate (1–<5 days used/week) and heavy (≥5 days used/week). Generalized estimating equations modeled associations of HIV, cannabis use category, and their interaction with cognitive outcomes; trend analyses used cannabis frequency as a continuous variable. Due to group differences in proportion of females, sex differences could not be addressed.ResultsYWH had worse performance than YWoH in fluid cognition, memory, processing speed, and executive functioning. Adjusting for HIV status, heavy 30-day use, vs. no use, was associated with worse performance on fluid cognition, immediate and delayed word list recall, processing speed and executive functions. Relative to mild/moderate use, heavy use was associated with worse immediate and delayed story recall and executive functions. Results were similar for 180- and 365-day use. Interactions between HIV status and 30-day cannabis use category were not significant, although exploratory analyses employing cannabis use as a continuous measure suggested a linear relationship for YWoH of greater use with worse cognitive performance, while for YWH, non-linear relationships suggested better performance with mild/moderate use on some memory and executive functioning measures.ConclusionsThese results suggest ongoing heavy cannabis use is associated with worse cognitive performance among young adults. For YWH, however, mild to moderate levels of cannabis use may have a protective effect possibly through altering chronic neuroinflammation, although causality cannot be determined in this cross-sectional study. Understanding differential, population-specific effects of cannabis use frequency may be important in setting use guidelines.

BACKGROUND:Community capacity-building is the cornerstone of many public health initiatives, with increasing attention paid to community engagement, collective impact, and trauma-informed practices designed to support resiliency and promote health equity. Large-scale capacity-building projects proliferated during the global pandemic, highlighting the need for practical guidance and steps for efficiently responding to changing community needs and effectively communicating information across partnership and community members. The present qualitative longitudinal study provides a pragmatic framework for trauma-informed knowledge exchange across stakeholders in a large urban collective impact, capacity-building initiative designed to establish partnerships that engage community members, promote equity through tailored referrals and resource access, and address community needs and aspirations. METHODS:Interviews were conducted with the leads of nine agencies funded to implement regionally responsive strategies addressing adverse childhood experience-driven health needs among their diverse subcommunities, while offsetting the impact of trauma, building capacities and improving resource access. We aimed to capture (1) the socioecological context of traumatic experiences and health barriers that propelled agencies to participate in a trauma-informed initiative; (2) agency leads' vision for community health; and (3) unfolding approaches to the initiatives' complex work, spanning pre-pandemic community needs and pandemic era challenges. RESULTS:Agency leads' vision for healthy communities emerged from the strengths, adversity-driven challenges and health barriers of their communities; while focusing on relationship-building, trust-based engagement and equitable access to trauma-informed resources through knowledge exchange. Results support reflection-based learning practices that are characterized by a flexible mindset and action-oriented adaptability. Mechanisms that power multi-directional knowledge exchange included creative partnering; frameworks and trainings that address partnership and community needs; and actionable skill-building. Incorporating community members directly into the initiative's work exemplified the vision of an informed/resourced community, relationship-based engagement, use of adaptive practices and creative partnering. Lived experience staff provided a credibility bridge facilitating knowledge exchange between community and partnership members and creating power-sharing opportunities. CONCLUSIONS:Engagement in public health initiatives is essential for community well-being and responsive public health initiatives. These data provide an emerging framework for thoughtful engagement and knowledge exchange among partnership and community members, while highlighting knowledge exchange as a key impact for outcome consideration.

This paper explores the impact of an initiative designed to promote trauma resilient communities by mitigating social determinants of health and reducing health disparities through capacity-building partnerships. Nine regional partnerships in Los Angeles County were funded to build community capacity to adapt to and recover from traumatic events through outreach and engagement with community members, training related to the impact of trauma, linkages of community members to existing services, and developing new services for target populations. Primary quantitative and qualitative data on community impact were gathered from agency leads (N = 10), partnership members (N = 136), and community members (N = 42). A convergent sequential mixed methods design (qual → QUAN → qual) was selected to provide both breadth and depth of understanding about the impact of community capacity-building from multiple perspectives. From January 2018 through July 2023, partnerships conducted over 30,000 community capacity-building activities with over 1.4 M community members and created 101,370 successful linkages to resources and services among 12,663 unique community members. Agency leads, partnership members, and community members converged on three main themes describing the initiative’s impact: (1) Building more empowered and resilient communities; (2) Normalizing help-seeking and reducing the stigma of mental health; and (3) Connections within partnerships/families and with community members. On average, 82

Despite awareness about high rates of sexual abuse among girls in the juvenile justice system, little is known about the additional risk conferred upon sexually diverse (SD) youths, as well as the combined vulnerability of sexual abuse and commercial sexual exploitation of children (CSEC) - frequently a survival behavior amplifying disproportionate juvenile justice contact among SD and non-SD juvenile justice-involved (JJI) girls. In a sample of JJI-girls, we compared SD (n = 52) with non-SD (n = 46) JJI-girls on sexual victimization (e.g. sexual abuse occurring within different relationship-types, CSEC), and broader developmental adversity burden disadvantage (cumulative trauma/loss exposure-types) and distress (posttraumatic stress disorder [PTSD]; cumulative stressor-reactivity, grief-specific, and adversity-related symptoms), health distress/impairment, and sexual and physical health-risk indicators. While comparable on childhood sexual abuse frequency, SD JJI-girls reported greater cumulative sexual abuse severity across relationship-types, higher sexual abuse within non-familial contexts, and more CSEC involvement. They also reported more social determinants of health (e.g. trauma/loss exposure-types) and showed elevations on all health-risk indicators, and most cumulative adversity burden indicators, despite comparable PTSD severity. Our findings emphasize the need to consider multiple sexual victimization facets, including the combined vulnerability of sexual abuse and CSEC, and utilize cumulative developmental assessment approaches among youths vulnerable to maltreatment and exploitation.

Trauma-informed communities establish cross-sector coalitions that advocate for the use of trauma-informed practices. Whether and how communication occurs within newly established trauma-informed communities is unclear. We collected qualitative data and social network data from six trauma-informed community partnerships that received funding to build community capacity to address trauma across a range of special populations in Los Angeles county. We identified three communication network sub-types and highlight contributions of network leadership in setting the tone for cross-partnership communication. While partnership leaders shared the goal of strengthening cross-organizational communication, social network results illustrated a need to develop strategies that target these goals.

Background Trust is essential for healthy, reciprocal relationships; creating safe environments; engaging in transparent interactions; successfully negotiating power differentials; supporting equity and putting trauma informed approaches into practice. Less is known, however, about the ways that trust-building may be at the forefront of consideration during community capacity building efforts, what trust-building elements are perceived as essential for optimally engaging communities, and what practices might support these efforts. Methods The present study examines an evolving understanding of trust-building over the course of 3 years, from qualitative data derived during interviews with nine agency leads from a large and diverse urban community, who are spearheading community-based partnerships to create more trauma-informed communities and foster resiliency. Results Data reflected fourteen trust-building elements, captured by three themes: 1) Building relationships and engagement (e.g., behavioral practices such as meeting people “ where they are at ” and creating safe spaces ), 2) Embodying core values of trustworthiness (e.g., traits such as being transparent and embodying benevolence ), and 3) Sharing decision-making, championing autonomy, and addressing barriers to trust (e.g., collaborative practices such as creating a shared vision and goals and addressing systemic inequities ). These trust-building elements are presented in the Community Circle of Trust-Building, which provides an accessible, visual format that can facilitate capacity building efforts within organizations and with the broader community; guide the selection of training opportunities that support healthy interpersonal relationships; and aid in the identification of relevant, supporting frameworks (e.g., health equity, trauma-informed practices, inclusive leadership models). Conclusions Community engagement and trust are essential for overall health and well-being, increasing equitable access to resources, and supporting an effective and connected citizenry. These data shed light on opportunities for trust-building and thoughtful engagement among agencies working directly with community members in large urban areas.

Background: Transition age youth (TAY) experiencing mental illness, homelessness, and trauma face challenges in navigating the transition to adulthood. Age appropriate, trauma-informed support from peer specialists (PS) can assist TAY who have experienced trauma in navigating their transition to adulthood. Whether and how TAY PS are involved in trauma-informed community-based partnerships is unclear. This study explores TAY PS experiences with and social network positions in trauma-informed 'TAY-support networks.'Methods: Social network data were collected from four TAY-support networks. Structural analyses (network size and density) and core periphery analyses were conducted to elucidate TAY PS network positions, while focus groups were conducted with TAY PS to understand their experiences delivering services. Focus group data were analyzed using thematic analysis. Data were triangulated to understand whether and how focus group results expanded on our social network analysis.Results: TAY support networks included 194 persons (range: 32-55) and 26 TAY PS. In two networks, TAY PS were located at the network's core and periphery, and reported ongoing contributions to initiative activities. In two other networks, TAY PS were located at the network periphery and reported challenges with team communication.Conclusions: To maximize TAY PS contributions to multidisciplinary partnerships, organizations should 1) include TAY PS throughout program planning and implementation and 2) provide age-appropriate professional supports to TAY PS.

Adverse childhood experiences (ACEs) are social determinants of health that increase morbidity and mortality and are prevalent among juvenile justice-involved (JJI) youth. ACEs drive health-risk behaviors (e.g., substance use) that reflect maladaptive coping, increase arrest risk, and overlap with posttraumatic risk-seeking theoretically and reckless/self-destructive behaviors diagnostically. However, little is known, especially among girls, about cumulative developmental adversity burden distress (i.e., total cumulative/lifespan stressor reactivity, grief-specific and adversity-related symptoms, and adversity-driven maladaptive coping strategies by age 18) and associated health risk impacts. Therefore, we assessed (a) developmental adversity burden indicators capturing expanded ACEs (E-ACEs; reflecting cumulative losses and traumatic events), cumulative distress, and risk characteristics; (b) potential racial/ethnic differences in developmental adversity burden; and (c) predictors of maladaptive coping among 223 JJI girls. Participants averaged 15 E-ACEs, endorsing 61.0% of stressor reactivity reactions, 58.4% of cumulative grief-specific symptoms, 55.7% (avoidance) to 73.2% (arousal) of adversity-related symptoms, and 45.0% of adversity-driven maladaptive coping strategies. White JJI girls endorsed significantly higher stressor reactivity and maladaptive coping than Latina girls (e.g., 38.8% vs. 14.6% suicide attempts), ds = 0.56-0.71. Adaptive LASSO analyses of maladaptive coping highlighted primary contributions from stressor reactivity, arousal alterations (excluding reckless/self-destructive behaviors), and cognition/mood alterations but not E-ACEs, grief, avoidance, or intrusions. Participants reported high levels of all cumulative developmental adversity burden indicators (e.g., 81.6% reported reckless/self-destructive behaviors). Results support cumulative, adversity-informed, universal precautions and assessments. Further, emotion regulation interventions targeting stressor reactivity, cognition/mood alterations, and/or arousal alterations may be useful for JJI youth with maladaptive coping.

Despite profound adversity exposure (loss, trauma) among delinquents, with adversity linked to early-onset persistent delinquency [EOPD], externalizing syndromes (Conduct Disorder) continue to overshadow impairing internalizing syndromes. Three understudied factors potentially contribute to both syndromes among delinquents: bereavement-related distress [BRD] from death-exposures; psychopathy-spectrum traits associated with system-involvement; and emotional abuse, implicated in lifespan morbidities. Therefore, we characterized loss/BRD among 107 EOPD adolescent girls and boys, comparing: (1) psychopathology and maltreatment (emotional, physical and sexual abuse); and (2) adversity-related (BRD, Post-traumatic Stress Disorder [PTSD], maltreatment) and psychopathy-spectrum predictors of internalizing and externalizing syndromes. Death exposure was common, resulting in developmental disruptions (school difficulties: 49.4%) and clinically significant BRD (33.8%), with girls evidencing greater BRD severity. BRD and psychopathy-traits, not PTSD, positively predicted all youths' internalizing, and boys' externalizing, syndromes. More frequent physical abuse increased both syndromes among boys. Emotional abuse alone predicted girls' externalizing syndromes, highlighting the contribution of this overlooked maltreatment-type.

Parents can play a vital role in shaping teenagers' sexual attitudes, behavior, and contraceptive use through communication, however, less is known about how to modify parent-adolescent communication among youth with mental health problems. The impact of a family-based sexual risk prevention intervention on both observational and self-report of parent adolescent sexual communication was examined at 12-months among adolescents with mental health problems. Of the 721 parent- adolescent dyads recruited for the study, 167 videotapes of sexual discussions between parents and adolescent were coded for the family-based intervention and 191 videotapes for the active comparison. Longitudinal analyses examined differences between conditions (family-based vs. comparison) in self-reported and observed parent-adolescent sexual discussions and also examined the impact of gender on intervention response. More parent I-statements, healthier parent Body-Language, and fewer adolescent Negative Vocalizations were detected for family-based intervention participants 12 months after participating in the brief intervention (11 hours of total intervention time) relative to those in the comparison condition. Parents in the family-based intervention also self-reported better sexual communication at 12-months. The current study provides supporting evidence that a relatively brief family-based intervention was successful at addressing parent-adolescent sexual communication among a mental health sample.

Research supports cascading relationships among internalizing and externalizing symptoms, and academic problems. This constellation of problems is characteristic of early-onset, persistent delinquent [EOPD] youth, and appropriately targeted interventions accounting for this comorbidity may improve outcomes. To investigate these relationships in EOPD youth, we characterized their cross-diagnostic psychopathology and verbal (word-list) learning/memory and evaluated: 1) verbal learning/memory profiles of Withdrawn/Depressed relative to Non-Withdrawn/Depressed youth; 2) cognitive and psychiatric predictors of verbal learning; and 3) emotion regulation as a mediator of psychiatric and cognitive relationships. Results indicated Withdrawn/Depressed youth recalled significantly fewer words during immediate, and some delayed, recall conditions. Less word-learning was predicted by: Withdrawn/Depressed classification, higher trauma-specific re-experiencing symptoms, greater emotion dysregulation, weaker executive skills, fewer trauma-avoidance and aggressive symptoms, and earlier alcohol-use onset. Emotion regulation strongly mediated the relationship between verbal learning and psychopathology, but not other cognitive skills, among these youth at high-risk for school dropout. Mental health and education implications are discussed.

AimPsychotic‐spectrum symptoms are linked to trauma, substance/alcohol use (SAU), criminality/violence and poor functional outcomes, supporting the need for early detection in vulnerable populations. To better understand high‐risk girls’ mental health, we assessed: (1) psychotic‐spectrum symptoms; (2) cumulative trauma, adversity and loss exposures (C‐TALE) and adversity‐indicators (symptoms, maladaptive coping, stressor‐reactivity); and SAU risk‐factors; and (3) relationships among psychotic‐spectrum symptoms, adversity‐indicators and SAU risk‐factors.MethodsWe administered the Structured Clinical Interviews for Psychotic Spectrum, and Trauma and Loss Spectrum to 158 adolescent delinquent girls.ResultsGirls’ psychotic‐spectrum profiles were similar to previously reported adult psychotic patients and characterized by typical symptoms (hallucinations/delusions, reported largely SAU‐independent), interpersonal sensitivity, schizoid traits and paranoia (over‐interpretation, anger over‐reactivity, hypervigilance). Auditory/visual hallucinations (55.7%), delusions (92.4%), ideas of reference (96.8%) and adversity (90.0% ≥10/24 C‐TALE‐types) were common. Mean loss (4) and trauma (8) onset‐age occurred before SAU‐onset (12). Significant positive correlations were found among psychotic‐spectrum symptoms, stressor‐reactivity, C‐TALE, adversity‐indicators; and number of SAU‐types; and a negative correlation occurred between psychotic‐spectrum symptoms and earlier alcohol use onset. After controlling for number of SAU‐types, stressor‐reactivity and adversity‐related numbing individually had the largest associations with total psychotic‐spectrum symptoms (b = 2.6‐4.3). Girls averaged more than 4 maladaptive coping strategies (e.g., 24.8% attempted suicide) in response to adversity, amplifying potential health‐disparities. No racial/ethnic differences emerged on psychotic‐spectrum symptoms.ConclusionsThis symptom constellation during adolescence likely interferes with social and academic functioning. Whether representing a prodromal phase, trauma‐response or cross‐diagnostic psychopathology, accurate early detection and appropriate treatment of psychotic‐spectrum symptoms are warranted to improve functional outcomes in vulnerable populations.

OBJECTIVE:Sexual activity often begins in early adolescence, and adolescents with mental health symptoms are at greater risk for sexual activity and other health risks. This study aimed to evaluate a developmentally targeted intervention designed to enhance early adolescents' emotion regulation competencies as a strategy for reducing health risk behaviors, including sexual initiation.METHOD:Adolescents 12 to 14 years old (N = 420; 53% male) with mental health symptoms participated in either an emotion regulation (ER) or health promotion (HP) intervention consisting of 12 after-school sessions. Participants completed questionnaires on laptop computers at baseline, 2-, 6-, and 12-month follow-ups.RESULTS:Time to event analyses were used to compare intervention conditions on rate of initiation to vaginal sex. Results showed that participants in the ER condition were less likely to transition into vaginal sexual activity by 1-year follow-up than were those in the HP condition (adjusted hazard ratio = 0.58, 95% confidence interval [0.36, 0.94], p = .01). However, those who were sexually active did not report differences in sexual risk behaviors (e.g., condomless sex). Participants in the ER condition were significantly less likely to report violence behaviors and showed improvement on a behavioral measure of emotion identification; however, they did not differ from HP participants on self-reports of emotional competence.CONCLUSIONS:Emotion regulation strategies can be used to delay sexual initiation among early adolescents with mental health symptoms and may have an important role in health education. (PsycINFO Database Record

Delinquent youth have substantial trauma exposure, with life-course persistent delinquents [LCPD] demonstrating notably elevated cross-diagnostic psychopathology and cognitive deficits. Because adolescents remain in the midst of brain and neurocognitive development, tailored interventions are key to improving functional outcomes. This structural magnetic resonance imaging study compared neuroanatomical profiles of 23 LCPD and 20 matched control adolescent boys. LCPD youth had smaller overall gray matter, and left hippocampal, volumes alongside less cortical surface area and folding within the left pars opercularis and supramarginal cortex. LCPD youth had more adversity-related exposures, and their higher Cumulative Trauma, Adversity and Grief [C-TAG] symptoms were associated with less surface area and folding in the pars opercularis and lingual gyrus. Neuroanatomical differences between LCPD and control youth overlap with data from both maltreatment and antisocial literatures. The affected left frontal regions also share connections to language- and executive-related functions, aligning well with LCPD youths' cognitive and behavioral difficulties. These data also dovetail with research suggesting the possibility of neurodevelopmental delays or disruptions related to cumulative adversity burden. Thus, concurrent treatment of LCPD youths' C-TAG symptoms and, cognitive deficits with overlapping neuroanatomical bases, may be most effective in improving outcomes and optimizing neurodevelopmental trajectories.

Despite growing recognition that cumulative adversity (total stressor exposure, including complex trauma), increases the risk for psychopathology and impacts development, assessment strategies lag behind: Adversity-related mental health needs (symptoms, functional impairment, maladaptive coping) are typically assessed in response to only one qualifying Criterion-A traumatic event. This is especially problematic for youth at-risk for health and academic disparities who experience cumulative adversity, including non-qualifying events (separation from caregivers) which may produce more impairing symptomatology. Data from 118 delinquent girls demonstrate: (1) an average of 14 adverse Criterion-A and non-Criterion event exposures; (2) serious maladaptive coping strategies (self-injury) directly in response to cumulative adversity; (3) more cumulative adversity-related than worst-event related symptomatology and functional impairment; and (4) comparable symptomatology, but greater functional impairment, in response to non-Criterion events. These data support the evaluation of mental health needs in response to cumulative adversity for optimal identification and tailoring of services in high-risk populations to reduce disparities.

Cognitive functioning affects health. This study assessed cognitive functioning among participants in the Northwestern Juvenile Project, a stratified random sample of 1,829 newly detained juveniles (10 to 18 years old) from Cook County, Illinois. The study examined receptive vocabulary, oral reading, arithmetic computation skills, and general intellectual abilities. The sample exhibited impaired overall intellectual functioning and deficits in all areas. Males performed more poorly than females. More than three quarters of males showed below average overall intellectual functioning, and 9 in 10 had below average receptive vocabulary skills. Hispanic and African American males performed more poorly than non-Hispanic White males. The multiple systems that serve delinquent youth-correctional, health, legal, and rehabilitative-must collaborate to tailor needed services to the cognitive level of youth in the juvenile justice system.

Cognitive functioning affects health. This study assessed cognitive functioning among participants in the Northwestern Juvenile Project, a stratified random sample of 1,829 newly detained juveniles (10 to 18 years old) from Cook County, Illinois. The study examined receptive vocabulary, oral reading, arithmetic computation skills, and general intellectual abilities. The sample exhibited impaired overall intellectual functioning and deficits in all areas. Males performed more poorly than females. More than three quarters of males showed below average overall intellectual functioning, and 9 in 10 had below average receptive vocabulary skills. Hispanic and African American males performed more poorly than non-Hispanic White males. The multiple systems that serve delinquent youth—correctional, health, legal, and rehabilitative—must collaborate to tailor needed services to the cognitive level of youth in the juvenile justice system.

This study evaluated a community-based correctional program in California, in which parolees tested positive on illicit drugs were given the option of going into a treatment program or having their parole revoked and returned to prison in California. Two comparison groups were constructed to assess the treatment effecta propensity-based comparison group extracted from the general parolee population and program dropouts. Although implicitly coercive, some parolees who finished the program were less likely to be reincarcerated 12 months following release than both comparison groups. However, the observed treatment advantage quickly eroded in the second observation year. Savings realized from the incarcerations avoided were more than enough to pay for the program. Findings from this study suggest that boosting participation in reentry services through coercive measures may yield currently unrealized individual and societal benefits. However, systemic efforts are needed to extend the short-term treatment effects. Design and data limitations in the study weaken the persuasiveness of these findings. Methodological implications and policy issues about coerced treatment are discussed.

This study evaluated a community-based correctional program in California, in which parolees tested positive on illicit drugs were given the option of going into a treatment program or having their parole revoked and returned to prison in California. Two comparison groups were constructed to assess the treatment effect—a propensity-based comparison group extracted from the general parolee population and program dropouts. Although implicitly coercive, some parolees who finished the program were less likely to be reincarcerated 12 months following release than both comparison groups. However, the observed treatment advantage quickly eroded in the second observation year. Savings realized from the incarcerations avoided were more than enough to pay for the program. Findings from this study suggest that boosting participation in reentry services through coercive measures may yield currently unrealized individual and societal benefits. However, systemic efforts are needed to extend the short-term treatment effects. Design and data limitations in the study weaken the persuasiveness of these findings. Methodological implications and policy issues about coerced treatment are discussed.

We evaluated the preliminary effectiveness of a novel intervention that was developed to address combat stress injuries in active-duty military personnel. Adaptive disclosure (AD) is relatively brief to accommodate the busy schedules of active-duty service members while training for future deployments. Further, AD takes into account unique aspects of the phenomenology of military service in war in order to address difficulties such as moral injury and traumatic loss that may not receive adequate and explicit attention by conventional treatments that primarily address fear-inducing life-threatening experiences and sequelae. In this program development and evaluation open trial, 44 marines received AD while in garrison. It was well tolerated and, despite the brief treatment duration, promoted significant reductions in PTSD, depression, negative posttraumatic appraisals, and was also associated with increases in posttraumatic growth.