Multisite implementation research in justice and health settings often does not systematically assess differential degrees of project involvement among participating sites, despite its implications for both research and the intervention. Tracking organization and participant involvement across sites, when attempted, has typically entailed the use of discrete and sometimes disjointed fidelity measures that may not accurately reflect engagement with a project. This article advances a more comprehensive and sophisticated conceptual model for measuring and monitoring site engagement. This conceptual model was developed from a literature review of the implementation science and related disciplines while being informed by multisite project implementation experience. We propose the Site Engagement Activity Model Leveraging Implementation Science (SEAMLIS), a conceptual model that holistically identifies the breadth of agency participation (diverse activities such as trainings, meetings, etc.) and duration of site engagement (participation levels from inception to completion) to be measured, assessed, and reported. We also describe Juvenile Justice Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS), a 36-site implementation research project, as an illustrative case example of our proposed model. We then operationalize all proposed domains and subdomains and specify key measures from the project. We provide analytical recommendations for the application and future research of the proposed model in health and justice settings. In multisite implementation research, site engagement could be fruitfully used as an independent, dependent, or intervening (moderating or mediating) variable. NCT02672150, February 3, 2016.

Intersectionality, especially with a race–class–gender focus, has been used to study many facets of women’s experiences. However, this framework has been underutilized in the study of breastfeeding prevalence. Our study is the first of its kind to use intersectionality to illuminate breastfeeding network prevalence disparities with empirical data. We use insights from this theory to examine breastfeeding patterns reported by women living on the Mississippi Gulf Coast. Mississippi makes an excellent site for such an examination, given its history of racial discrimination, entrenched poverty, and strikingly low rates of breastfeeding, particularly for African American women. We identify a series of factors that influence racial disparities in lactation network prevalence, that is, breastfeeding among friends and family of the women we surveyed. Our investigation relies on survey data drawn from a random sample of adult women who are representative of the Mississippi Gulf Coast population supplemented by a non-random oversample of African American women in this predominantly rural tri-county area. Results from the first wave of the CDC-funded 2019 Mississippi REACH Social Climate Survey reveal that Black-White differentials in breastfeeding network prevalence are significantly reduced for African American women who report (1) higher income levels and (2) more robust community support for breastfeeding. We conclude that breastfeeding is subject to two key structural factors: economic standing and community context. An appreciation of these intersecting influences on breastfeeding and long-term efforts to alter them could bring about greater breastfeeding parity among African American and White women in Mississippi and perhaps elsewhere. We end by identifying the practical implications of our findings and promising directions for future research.

There are significant hurdles to placing pregnant and parenting women (PPW) with a substance use disorder into treatment programs. This study uses qualitative analysis of case notes collected by a linkage to care expert (patient navigator) from over 50 Mississippi PPW client cases. The analysis identified facilitators and barriers in the referral to treatment process. We group the observed patterns into three general categories: (1) individual factors such as motivation to change and management of emotions; (2) interpersonal relationships such as romantic partner support or obstruction; and (3) institutional contexts that include child welfare, judicial, and mental health systems. These factors intersect with one another in complex ways. This study adds to prior research on gender-based health disparities that are often magnified for pregnant and parenting women.

In this study, we formally examine the association between penis size dissatisfaction and gun ownership in America. The primary hypothesis, derived from the psychosexual theory of gun ownership, asserts that men who are more dissatisfied with the size of their penises will be more likely to personally own guns. To test this hypothesis, we used data collected from the 2023 Masculinity, Sexual Health, and Politics ( MSHAP ) survey, a national probability sample of 1,840 men, and regression analyses to model personal gun ownership as a function of penis size dissatisfaction, experiences with penis enlargement, social desirability, masculinity, body mass, mental health, and a range of sociodemographic characteristics. We find that men who are more dissatisfied with the size of their penises are less likely to personally own guns across outcomes, including any gun ownership, military-style rifle ownership, and total number of guns owned. The inverse association between penis size dissatisfaction and gun ownership is linear; however, the association is weakest among men ages 60 and older. With these findings in mind, we failed to observe any differences in personal gun ownership between men who have and have not attempted penis enlargement. To our knowledge, this is the first study to formally examine the association between penis size and personal gun ownership in America. Our findings fail to support the psychosexual theory of gun ownership. Alternative theories are posited for the apparent inverse association between penis size dissatisfaction and personal gun ownership, including higher levels of testosterone and constructionist explanations.

Purpose and method: The association between illegal activity and substance use (SU) is prominent in juvenile populations, underscoring the importance of gaining a better understanding about SU treatment as a strategy to reduce recidivism. Youth records (N = 9165) from 12 juvenile justice programs in JJ-TRIALS examined the impact of treatment on the relationship between treatment need and time to recidivism. Results: The 4-step mediation analysis demonstrated: (1) treatment need significantly relates to time to recidivism (p < .0002); (2) treatment need positively predicts treatment length (p <= .0001); (3) treatment length positively predicts time to recidivism (p < .0001); and (4), full mediation. Specifically, more treatment significantly predicted a longer time to recidivism such that youth with an identified need receiving treatment (Group A) had a longer time to recidivism than youth with a treatment need who did not receive services (Group B). A survival distribution curve illustrates that 14 % of youth in Group A had a recidivism event during the study, compared to 98 % of youth in Group B. Conclusions: Outcomes point to the benefit of expanded treatment services for youth in juvenile justice. Services include early identification of treatment needs, treatment referrals, and treatment receipt to reduce recidivism risk.

The rise in suicides among elementary- to high-school-aged youth has alarmed health professionals for years, only to be amplified by the long-lasting effects of the COVID-19 pandemic. Religion and spirituality offer many people significant psychosocial support in pandemic circumstances, often acting as platforms for hope and social connectedness. Yet, given the adultocentric world they inhabit, young people must often negotiate or reconsider the role of religion and spirituality in the context of their developmental trajectory. This research explores mental health professionals’ approaches to religiosity and spirituality in the delivery of therapeutic care to youth at risk of suicide. Qualitative analyses of interview transcripts conducted with youth mental health clinicians in the state of Texas underscore a myriad of contextual factors related to treating suicidal ideation and behaviors. We categorize our findings according to licensed mental health professionals’ (1) navigation of youth clients’ religious/spiritual preferences aligned with or opposed to familial preferences; (2) selective integration of youth-oriented religious/spiritual elements into treatment as warranted; and (3) reflections on the impacts of religion/spirituality on treatment efficacy for child and adolescent clients. This study adds to current research on religion and spirituality’s impact on mental health and its therapeutic integration into treatment practices tailored for youth.

Medical professionals are rarely trained to treat the unique healthcare needs and health disparities of people with intellectual and developmental disabilities (IDD). The Curriculum in IDD Healthcare (CIDDH) eLearn course aims to redress gaps in the delivery of medical care to people with IDD. An initial comprehensive evaluation of CIDDH in-person training content had previously underscored its knowledge and skill transfer efficacy for Mississippi healthcare providers. Training content has recently become available to medical professionals nationwide through an online self-paced modality to address physicians’ IDD education needs. This study introduces and applies a new evaluation framework called SEAM (Streamlined Evaluation and Analysis Method) that offers a promising avenue for rendering a follow-up appraisal after rigorous evidence of program effectiveness has been previously established. SEAM reduces the data-reporting burden on trainees and maximizes instructor–trainee contact time by relying on an abbreviated post-only questionnaire focused on subjective trainee appraisals. It further reduces methodological and analytical complexity to enhance programmatic self-assessment and facilitate sound data interpretation when an external evaluator is unavailable. Ratings from a small sample of early-cohort trainees provide an important test of effectiveness during CIDDH’s transition to online learning for clinicians nationwide. Using SEAM, CIDDH achieved high ratings from this initial wave of trainees across various evaluative domains. The study concludes by highlighting several promising implications for CIDDH and SEAM.

Suicide continues to be a leading cause of mortality for young people. Given persistent intersecting forms of disadvantage, Native American adolescents are especially vulnerable to mental health adversities and other suicide risk factors. The Mississippi Band of Choctaw Indians (MBCI) implemented the Choctaw Youth Resilience Initiative (CYRI), a five-year SAMHSA-funded project that began in 2019. This study uses Choctaw student pre-test/post-test survey data to examine the effectiveness of the Hazelden Lifelines Suicide Prevention Training curriculum for youth. A lagged post-test design was used, whereby post-surveys were administered at least one month after program completion. Several intriguing results were observed. First, the lagged post-test model was subject to some pre-to-post attrition, although such attrition was comparable to a standard pre/post design. Second, analyses of completed surveys using means indicated various beneficial effects associated with the Lifelines curriculum implementation. The greatest benefit of the program was a significant change in student perceptions concerning school readiness in response to a suicidal event. Some opportunities for program improvement were also observed. Our study sheds new light on suicide prevention training programs that can be adapted according to Native American youth culture. Program implementation and evaluation implications are discussed in light of these findings.

Youth suicide risks have been on the rise or persistently elevated for decades, and Native American communities are especially vulnerable. This study provides a promising framework for suicide prevention among underserved populations in the U.S., especially Native American communities in states lacking strong suicide prevention supports. Our investigation reports the evaluation results of the Question–Persuade–Refer (QPR) gatekeeper training program, a key component of the SAMHSA-funded Choctaw Youth Resilience Initiative (CYRI) implemented by the Mississippi Band of Choctaw Indians (MBCI). QPR trains adult gatekeepers to identify youth at risk of suicide and refer them to certified mental health service providers. Standardized QPR pre-test and post-test training surveys were administered at in-person trainings delivered to youth-serving MBCI organization leaders and staff. Statistical analyses of all survey items indicate that QPR gatekeeper trainings significantly enhanced the knowledge of prevention practices and risk identification skills for the MBCI trainees. The robust evidence of positive changes revealed in this study suggests that QPR can be an effective suicide prevention program for underserved minority communities, especially Native American populations in rural states where suicide is a persistent and leading cause of mortality.

Background/Objectives: Breastfeeding rates are considerably lower among African American women and across the U.S. South. Our study introduces the concept of community-based peer support for breastfeeding, as measured through beliefs about women’s comfort breastfeeding in various social situations (i.e., in the presence of women and men as well as close friends and strangers). Methods: We examine if community-based peer support for breastfeeding is associated with reported lactation prevalence in primary social networks among survey respondents living on the Mississippi Gulf Coast. Special attention is paid to racial differences in the breastfeeding support–prevalence relationship. We use data drawn from a survey that combines a random sample of adults who are representative of the Mississippi Gulf Coast population and a non-random oversample of African Americans in this predominantly rural tri-county area. Results: Analyses of data from wave 1 of the CDC-funded 2019 Mississippi REACH Social Climate Survey reveal low overall levels of African American breastfeeding network prevalence (knowing friends and family who have breastfed). However, community-based peer support for breastfeeding significantly amplifies breastfeeding network prevalence for black Mississippians when compared with their white counterparts. Discussion: Previous research has indicated that breastfeeding promotional messages have a limited impact on African American breastfeeding propensity along the Mississippi Gulf Coast. However, the current study indicates that enhanced community-based peer support for breastfeeding can be a key facilitator for improved lactation outcomes among African Americans as compared with whites. Conclusion: We establish that breastfeeding is best conceived as both an interpersonal encounter (an activity often conducted in the presence of others) and a collective achievement (a practice influenced by community norms). We discuss study implications and directions for future research.

Previous research has established attitudinal and behavioral health variations in relation to the COVID-19 pandemic, but scholarship on the religious antecedents associated with these outcomes has only recently gained momentum. Rhetoric from some leading conservative Protestants in the U.S. has underplayed the threat of the pandemic and may have contributed to unhealthy pandemic behaviors within this faith tradition. Moreover, previous inquiries have revealed that conservative Protestantism’s otherworldly focus can thwart personal and community health. We use nationally representative data to test the hypotheses that, compared with other religious groups and the non-religious, conservative Protestants will tend to (1) perceive the pandemic as less threatening and (2) engage in riskier pandemic lifestyles. These hypotheses are generally supported net of confounding factors. We conclude that affiliation with a conservative Protestant denomination can undermine public health among this faith tradition’s adherents and may therefore compromise general health and well-being during a pandemic. We discuss the implications of these findings, offer recommendations for pandemic health promotion among conservative Protestants, and delineate promising avenues for future research on this important topic.

BackgroundDespite the heightened risk for substance use (SU) among youth in the juvenile justice system, many do not receive the treatment that they need.ObjectivesThe purpose of this study is to examine the extent to which youth under community supervision by juvenile justice agencies receive community-based SU services and the factors associated with access to such services.MethodsData are from a nationally representative sample of Community Supervision (CS) agencies and their primary behavioral health (BH) partners. Surveys were completed by 192 CS and 271 BH agencies.ResultsSU services are more often available through BH than CS for all treatment modalities. EBPs are more likely to be used by BH than by CS. Co-location of services occurs most often in communities with fewer treatment options and is associated with higher interagency collaboration. Youth are more likely to receive services in communities with higher EBP use, which mediates the relationship between the availability of SU treatment modalities and the proportion of youth served.ConclusionFindings identify opportunities to strengthen community systems and improve linkage to care.

American support for the death penalty has declined over time, but conservative religious groups have exhibited more favorable attitudes toward this practice than their mainline religious and secular peers. Scholars have generally overlooked Latter-day Saint (LDS, Mormon) support for capital punishment. However, this faith tradition is a case worthy of careful examination. Historically, LDS leadership was supportive of the death penalty, which was congruent with their teachings on blood atonement, i.e., theological rationales for capital punishment as a just response to murder. However, Mormon leaders have more recently adopted a neutral position toward the death penalty. To what degree might changing social attitudes and flagging LDS leader endorsements of the death penalty have contributed to diminished grassroots Mormon support for capital punishment? This study uses data from the General Social Survey to test three hypotheses: (1) those with an LDS affiliation will exhibit greater support for the death penalty when compared with their non-Mormon peers, including other religious conservatives; (2) LDS support for the death penalty will diminish over time; and (3) LDS support for capital punishment will be bolstered by frequent Mormon worship service attendance. Using cross-tabulations, logistic regression, and time series analyses, the results indicate support for all three hypotheses. Implications and directions for future research are discussed.

Religious affiliation and attendance have been shown to affect various facets of mental health, including the willingness to seek mental health assistance; however, little is known about how theological beliefs influence people's assessments of religious and secular mental health assistance options. Prior research using theological conservatism (beliefs about scripture, sin, and salvation) has conceptualized this perspective as being a schema in which the dimensions operate in tandem. Nonetheless, given the personalized nature of mental health, this study has conceptualized this perspective as three interrelated, but distinctly different dimensions of a religious belief system. Using data from the NORC General Social Survey's (GSS) 2006 and 2018 waves (N = 2563), this study enlists a fruitful but underutilized approach to gauging perceptions of mental health assistance through the use of situational vignettes that prompt survey respondent appraisals of different sets of circumstances and various possible solutions. This study finds some support for the hypothesis that predicted theological conservatism would be associated with a more favorable view of religious support for mental health as opposed to secular sources of assistance; there was also considerable support for the hypothesis that the salvation dimension of this worldview would exhibit an influence apart from the scripture and sin dimensions. This investigation sheds light on an understudied facet of religion in relation to receptivity toward distinctive forms of mental health treatment and highlights potential directions for future research.

Background Most justice-involved youth are supervised in community settings, where assessment and linkage to substance use (SU) treatment services are inconsistent and fragmented. Only 1/3 of youth with an identified SU need receive a treatment referral and even fewer initiate services. Thus, improving identification and linkage to treatment requires coordination across juvenile justice (JJ) and behavioral health (BH) agencies. The current study examines the comparative effectiveness of two bundled implementation intervention strategies for improving SU treatment initiation, engagement, and continuing care among justice-involved youth supervised in community settings. Exploration, Preparation, Implementation, Sustainment (EPIS) served as the conceptual framework for study design and selection/timing of implementation intervention components, and the BH Services Cascade served as the conceptual and measurement framework for identifying and addressing gaps in service receipt. Methods Part of a larger Juvenile-Justice Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS) Cooperative, this study involved a multisite, cluster-randomized control trial where sites were paired then randomly assigned to receive Core (training teams on the BH Services Cascade and data-driven decision making; supporting goal selection) or Core+Enhanced (external facilitation of implementation teams) intervention components. Youth service records were collected from 20 JJ community supervision agencies (in five states) across five study phases (baseline, pre-randomization, early experiment, late experiment, maintenance). Implementation teams comprised of JJ and BH staff collaboratively identified goals along the BH Cascade and used data-driven decision-making to implement change. Results Results suggest that Core intervention components were effective at increasing service receipt over time relative to baseline, but differences between Core and Core+Enhanced conditions were non-significant. Time to service initiation was shorter among Core+Enhanced sites, and deeper Cascade penetration occurred when external facilitation (of implementation teams) was provided. Wide variation existed in the degree and nature of change across service systems. Conclusions Findings demonstrate the criticality of early EPIS phases, demonstrating that strategies provided during the formative exploration and preparation phases produced some improvement in service receipt, whereas implementation-focused activities produced incremental improvement in moving youth farther along the Cascade.

Suicidal ideation and deaths among children and adolescents have seen an unprecedented rise over the last ten years, recently further exacerbated by the COVID-19 pandemic. This research explores mental health professionals’ approaches to delivering suicide prevention treatment services. Using insights from Giddens’ structuration theory, the study examines licensed mental health professionals’ (1) reflections on suicide prevention trainings for those in their profession, (2) appraisals of available treatment options, and (3) assessments of postvention services provided to professionals who encounter a client suicide. Additional attention was given to the structural impacts of the COVID-19 pandemic on intervention services. Data were collected through qualitative interviews with youth mental health clinicians in the state of Texas. Results underscore the interplay between structural influences and practitioner innovations in the delivery of these essential services to a vulnerable population. This study underscores the agency of mental health professionals in navigating the demands of a difficult profession.

This study employed national cross-sectional survey data from the 2021 Crime, Health, and Politics Survey (n = 1578 to 1735) to model traditional cigarette and e-cigarette use as a function of religious affiliation, general religiosity, biblical literalism, religious struggles, and the sense of divine control. Although the odds of abstaining from cigarettes and e-cigarettes were comparable for conservative Protestants and non-affiliates, conservative Protestants were more likely to cut down on cigarettes and e-cigarettes during the pandemic. Religiosity increased the odds of abstaining from cigarettes (not e-cigarettes) and reduced pandemic consumption of cigarettes and e-cigarettes. Biblical literalism was unrelated to abstaining from cigarettes and pandemic changes in cigarette use; however, biblical literalists were more likely to cut e-cigarette use during the pandemic. While the sense of divine control was unrelated to abstaining from cigarettes and e-cigarettes, these beliefs increased the odds of cessation from traditional and e-cigarette use. Finally, our religious struggles index was unrelated to smoking behavior. Our study is among the first to report any association between religion and lower e-cigarette use.