Complex Systems Science and Community-Based Research

There is an abundance of community-based research literature that incorporates complex system science concepts and techniques. However, currently there is a gap in how these concepts and techniques are being used, and, more broadly, how these two fields complement one another. The debate on how complex systems science meaningfully bolsters the deployment of community-based research has not yet reached consensus, therefore, we present a protocol for a new scoping review that will identify characteristics at the intersection of community-based research and complex systems science. This knowledge will enhance the understanding of how complex systems science, a quickly evolving field, is being utilized in community-based research and practice

Evidence of Syndemics and Sexuality-Related Discrimination Among Young Sexual-Minority Women

Purpose: Syndemics, or the co-occurrence and interaction of health problems, have been examined extensively among young men who have sex with men, but their existence remain unexamined, to our knowledge, among sexual-minority (i.e., lesbian, gay, and bisexual) women. Thus, we investigated if syndemics were present among young sexual-minority women, and if sexual-orientation discrimination was an independent variable of syndemic production. Methods: A total of 467 sexual-minority women between the ages of 18 and 24 completed a cross-sectional online survey regarding their substance use, mental health, sexual behaviors, height, weight, and experiences of discrimination. We used structural equation modeling to investigate the presence of syndemics and their relationship to sexual-orientation discrimination. Results: Heavy episodic drinking, marijuana use, ecstasy use, hallucinogen use, depressive symptoms, multiple sexual partners, and history of sexually transmitted infections (STIs) comprised syndemics in this population (chi-square=24.989, P=.201; comparative fit index [CFI]=0.946; root mean square error of approximation [RMSEA]=0.023). Sexual-orientation discrimination is significantly and positively associated with the latent syndemic variable (unstandardized coefficient=0.095, P.05). Conclusions: Syndemics appear to be present and associated with sexual-orientation discrimination among young sexual-minority women. Interventions aimed at reducing discrimination or increasing healthy coping may help reduce substance use, depressive symptoms, and sexual risk behaviors in this population.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140158/1/lgbt.2014.0063.pd

Pilot testing the feasibility of a game intervention aimed at improving help seeking and coping among sexual and gender minority youth: protocol for a randomized controlled trial

Background: Sexual and gender minority youth (SGMY; e.g., lesbian, gay, bisexual, and transgender youth) experience myriad substance use and mental health disparities compared with their cisgender (non-transgender) heterosexual peers. Despite much research showing these disparities are driven by experiences of bullying and cyberbullying victimization, few interventions have aimed to improve the health of bullied SGMY. One possible way to improve the health of bullied SGMY is via an online-accessible game intervention. Nevertheless, little research has examined the feasibility of using an online-accessible game intervention with SGMY. Objectives: To describe the protocol for a randomized controlled trial (RCT) pilot testing the feasibility and limited-efficacy of a game-based intervention for increasing help-seeking-related knowledge, intentions, self-efficacy, and behaviors, productive coping skills use, and coping flexibility, and reducing health risk factors and behaviors among SGMY. Methods: We enrolled 240 SGMY aged 14-18 years residing in the United States into a two-arm prospective RCT. The intervention is a theory-based, community-informed, computer-based, role playing game with three primary components: (1) encouraging help-seeking behaviors; (2) encouraging use of productive coping; and (3) raising awareness of online resources. SGMY randomized to both the intervention and control conditions will receive a list of SGMY-inclusive resources covering a variety of health-related topics. Control condition participants received only the list of resources. Notably, all study procedures are conducted online. We conveniently sampled SGMY using online website advertisements. Study assessments occur at enrollment, 1 month after enrollment, and 2 months after enrollment. The primary outcomes of this feasibility study include implementation procedures, game demand, and game acceptability. Secondary outcomes include help-seeking intentions, self-efficacy, and behaviors; productive coping strategies and coping flexibility; and knowledge and use of online resources. Tertiary outcomes include bullying and cyberbullying victimization; loneliness; mental health issues; substance use; and internalized sexual and gender minority stigma. Results: From April through July 2018, 240 participants were enrolled and randomized. Half of the enrolled participants (n=120) were randomized into the intervention condition, and half (n=120) into the control condition. At baseline, 52% of participants identified as gay or lesbian, 27% as bisexual, 24% as queer, and 12% as another non-heterosexual identity. Nearly half (47%) of participants were a gender minority, 37% were cisgender boys, and 16% were cisgender girls. There were no differences in demographic characteristics between intervention and control condition participants. Data collection is anticipated to end in November 2018. Conclusions: Online-accessible game interventions overcome common impediments of face-to-face interventions and present a unique opportunity to reach SGMY and improve their health. This trial will provide data on feasibility and limited-efficacy that can inform future online studies and a larger RCT aimed at improving health equity for SGMY. Trial Registration: ClinicalTrials.gov NCT03501264; https://clinicaltrials.gov/ct2/show/NCT03501264 (Archived by WebCite at http://www.webcitation.org/72HpafarW

A chatbot-delivered intervention for optimizing social media use and reducing perceived isolation among rural-living LGBTQ+ youth: Development, acceptability, usability, satisfaction, and utility

Background: Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) youth are at higher risk of isolation and depression than their heterosexual peers. Having access to tailored mental health resources is a documented concern for rural living LGBTQ+ youth. Social media provides access to connections to a broader and like-minded community of peers, but it also is a vehicle for negative interactions. We developed REALbot, an automated, social media–based educational intervention to improve social media efficacy, reduce perceived isolation, and bolster connections for rural living LGBTQ+ youth. This report presents data on the acceptability, feasibility, and utility of REALbot among its target audience of rural living LGBTQ+ youth. Methods: We conducted a week-long exploratory study with a single non-comparison group of 20 rural-living LGBTQ+ youth aged 14–19 recruited from social media to test our Facebook- and Instagram-delivered chatbot. We assessed pre- and post-test scores of social media self-efficacy, social isolation (4-item Patient-Reported Outcomes Measurement System – PROMIS), and depressive symptoms (Patient Health Questionnaire, Adolescent Version – PHQ-A). At post-test, we assessed acceptability (User Experience Questionnaire – UEQS), usability (Chatbot Usability Questionnaire –CUQ and Post-Study Satisfaction and Usability Questionnaire –PSSUQ), and satisfaction with the chatbot (Client Satisfaction Questionnaire – CSQ), along with two open-ended questions on ‘likes’ and ‘dislikes’ about the intervention. We compared pre- and post-test scores with standard univariate statistics. Means and standard deviations were calculated for usability, acceptability, and satisfaction. To analyze the responses to post-test open-end questions, we used a content analysis approach. Results: Acceptability of REALbot was high with UEQ-S 5.3 out of 7 (SD = 1.1) and received high usability scores with CUQ and PSSUQ (mean score (M) = 78.0, SD = 14.5 and M = 86.9, SD = 25.2, respectively), as well as high user satisfaction with CSQ (M = 24.9, SD = 5.4). Themes related to user ‘likes’ and ‘dislikes’ were organized in two main categories: usability and content provided. Participants were engaged with the chatbot, sending an average of 49.3 messages (SD = 43.6, median = 30). Pre-/post- changes in scores of perceived isolation, depressive symptoms and social media self-efficacy were not significant (p's > 0.08). Conclusion: REALbot deployment was found to be feasible and acceptable, with good usability and user satisfaction scores. Participants reported changes from pre- to post-test in most outcomes of interest and effect sizes were small to medium. Additional development and a formal evaluation of feasibility and engagement with behavioral targets is warranted

Examining psychosocial correlates of loneliness and perceived isolation among marginalized youth

Adolescents and emerging adults from marginalized groups (e.g., racial/ethnic, sexual, and gender minorities; rural-living) have disproportionately higher risk of mental health problems (e.g., depression, anxiety, suicidal thoughts and behaviors) and substance use than their peers from non-marginalized groups. Loneliness and perceived isolation are well-known predictors of mental health problems, and their prevalence among youth and emerging adults has significantly increased in the last decade. However, there is limited research to identify modifiable psychosocial, familial, interpersonal (in person and on social media), and structural factors that could reduce loneliness and perceived isolation in this population. We will partner with community-based organizations that serve marginalized youth and emerging adults with lived experience, to contextualize the experiences of feeling lonely and isolated. Then, we will leverage mixed methods (longitudinal survey study, focus groups/individual interviews) and social media data to uncover psychosocial, familial, interpersonal, and structural correlates of loneliness and perceived isolation, which can be used as targets for behavioral interventions for reducing loneliness, isolation, and associated mental health problems. We will use our findings to apply for extramural funding at the National Institutes of Health, which has calls directly related to loneliness and isolation (funding opportunities PAR-21-131, PAR-21-350, and PAR-21-134)

Feasibility of a web-accessible game-based intervention aimed at improving help seeking and coping among sexual and gender minority youth: results from a randomized controlled trial

PURPOSE: To address the gap in interventions for improving sexual and gender minority youth (SGMY; e.g., lesbian, gay, bisexual, and transgender youth) health, we tested the feasibility of a game-based intervention for increasing help-seeking, productive coping skills, resource knowledge/use, and well-being. METHODS: We conducted a 2-arm randomized controlled trial testing a theory-based, community-informed, Web-accessible computer role playing game intervention. Control condition received a list of resources. Primary hypotheses were high levels of implementation success, game demand, and game acceptability. RESULTS: We randomized 240 SGMY aged 14–18 into the intervention (n=120) or control (n=120) conditions. Participants completed baseline (100%), 1-month follow-up (T2; 73.3%), and 2-month follow-up (T3; 64.4%) surveys. Among intervention participants, 55.8% downloaded and played the game. Of those who played, 46.2% reported a desire to play it again and 50.8% would recommend it. Game acceptability exceeded hypothesized benchmarks, wherein participants reported high positive affect (M=2.36; 95% CI:2.13,2.58), low negative affect (M=2.75; 95% CI:2.55,2.95), low tension/annoyance (M=3.18; 95% CI:2.98,3.39), and high competence (M=2.23; 95% CI:2.04,2.43) while playing the game. In multivariable intent-to-treat analyses of 38 secondary/tertiary outcomes, intervention participants reported significantly larger reductions than control participants in cyberbullying victimization (T2 b=−0.28; 95% CI:−0.56,−0.01), binge drinking frequency (T2 b=−0.39; 95% CI:−0.71,−0.06), and marijuana use frequency (T3 b=−2.78; 95% CI:−4.49,−1.08). CONCLUSIONS: We successfully implemented a Web-accessible game trial with SGMY. The game-based intervention was feasible and acceptable to SGMY, and preliminary results show it improved several health-related behaviors. A larger scale trial is needed to test whether the game-based intervention can reduce health inequities for SGMY