- Chicago, Illinois, United States
Dennis H Li
Northwestern University, Psychiatry and Behavioral Sciences, Faculty Member
- Northwestern University, Medical Social Sciences, Post-DocRice University, Ecology and Evolutionary Biology, UndergraduateThe University of Texas Health Science Center at Houston, School of Public Health, Graduate Studentadd
BackgroundAdolescent men who have sex with men (AMSM), aged 13 to 18 years, account for more than 80% of teen HIV occurrences. Despite this disproportionate burden, there is a conspicuous lack of evidence-based HIV prevention programs.... more
BackgroundAdolescent men who have sex with men (AMSM), aged 13 to 18 years, account for more than 80% of teen HIV occurrences. Despite this disproportionate burden, there is a conspicuous lack of evidence-based HIV prevention programs. Implementation issues are critical as traditional HIV prevention delivery channels (eg, community-based organizations, schools) have significant access limitations for AMSM. As such, eHealth interventions, such as our proposed SMART program, represent an excellent modality for delivering AMSM-specific intervention material where youth are.ObjectiveThis randomized trial aimed to test the effectiveness of the SMART program in reducing condom-less anal sex and increasing condom self-efficacy, condom use intentions, and HIV testing for AMSM. We also plan to test whether SMART has differential effectiveness across important subgroups of AMSM based on race and ethnicity, urban versus rural residence, age, socioeconomic status, and participation in an English versus a Spanish version of SMART.MethodsUsing a sequential multiple assignment randomized trial design, we will evaluate the impact of a stepped-care package of increasingly intensive eHealth interventions (ie, the universal, information-based SMART Sex Ed; the more intensive, selective SMART Squad; and a higher cost, indicated SMART Sessions). All intervention content is available in English and Spanish. Participants are recruited primarily from social media sources using paid and unpaid advertisements.ResultsThe trial has enrolled 1285 AMSM aged 13 to 18 years, with a target enrollment of 1878. Recruitment concluded in June 2020. Participants were recruited from 49 US states as well as Puerto Rico and the District of Columbia. Assessments of intervention outcomes at 3, 6, 9, and 12 months are ongoing.ConclusionsSMART is the first web-based program for AMSM to take a stepped-care approach to sexual education and HIV prevention. This design indicates that SMART delivers resources to all adolescents, but more costly treatments (eg, video chat counseling in SMART Sessions) are conserved for individuals who need them the most. SMART has the potential to reach AMSM to provide them with a sex-positive curriculum that empowers them with the information, motivation, and skills to make better health choices.Trial RegistrationClinicalTrials.gov Identifier {"type":"clinical-trial","attrs":{"text":"NCT03511131","term_id":"NCT03511131"}}NCT03511131; https://clinicaltrials.gov/ct2/show/{"type":"clinical-trial","attrs":{"text":"NCT03511131","term_id":"NCT03511131"}}NCT03511131International Registered Report Identifier (IRRID)DERR1-10.2196/19701
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Background. India’s National AIDS Control Programme calls for, among other things, targeted behavioral interventions that address determinants contributing to new infections among men who have sex with men (MSM) and hijras (transgender... more
Background. India’s National AIDS Control Programme calls for, among other things, targeted behavioral interventions that address determinants contributing to new infections among men who have sex with men (MSM) and hijras (transgender women). Aim. To determine if the information–motivation–behavioral skills model was transferable to an Indian context. Methods. We recruited 442 MSM and 7 hijras into an online cross-sectional study that asked questions about condom use knowledge, motivation, self-efficacy, and sexual behavior. Structural equation modeling was used to test the overall information–motivation–behavioral skills structure. Results. Condom use and HIV risk knowledge did not significantly predict condom use self-efficacy or having condomless anal sex with more than one male partner in the past 3 months, and knowledge was not significantly correlated with attitudes toward barebacking. Despite this, the final structural model explained 14.4% of the variance in condom use self...
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Young men who have sex with men (MSM) and MSM of color carry the burden of HIV in the United States and are the priority target population for the CDC’s High-Impact HIV Prevention approach. This strategy calls for low-cost, large-scale... more
Young men who have sex with men (MSM) and MSM of color carry the burden of HIV in the United States and are the priority target population for the CDC’s High-Impact HIV Prevention approach. This strategy calls for low-cost, large-scale implementation of HIV-prevention interventions, many of which utilize digital media and leverage resources and a sense of connectedness to a larger “gay community.” However, this broad, sweeping approach reduces a heterogeneous population of men to a single risk behavior and eschews other factors that contribute to their health, likely impeding the ability to address specific needs of different MSM subgroups. More research is needed to understand differences within the MSM population and how they use the Internet and relate to the gay community. The relationship between digital media use and community connectedness was investigated in two samples of young MSM. In the first, YMSM aged 16–20 (N = 450) were examined for developmental heterogeneity using latent class and latent profile analyses, and the effect of the differential developmental trajectories on the association between gay-related Internet use and gay community affiliation was modeled using structural equation mixture modeling. In the second sample, the effects of online versus offline relationships at various levels of the social-ecological model on gay community cohesion were compared using multivariable logistic regression among YMSM aged 17–29 from two cities (N = 719). Latent class analyses identified 5 classes of experience patterns and 7 developmental trajectory profiles, supporting substantial heterogeneity within the first sample. Developmental trajectories were found to moderate the association between Internet use and community affiliation, suggesting that YMSM in different trajectory profiles use and respond to the Internet differently. Multivariable logistic regressions in the second sample found that only attendance at physical venues was significantly associated with gay community cohesion in both cities and that online relationships at the interpersonal and institutional levels were not associated with cohesion. The findings have implications for High Impact Prevention in that physical-venue-based interventions still show promise at increasing community connectedness, but online media should supplement offline interventions and be tailored to specific subgroups of MSM
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The aims of the present study were to examine whether Asian American youth experience disparities in quality of life (QL) compared with Hispanic, African American, and white youth in the general population and to what extent socioeconomic... more
The aims of the present study were to examine whether Asian American youth experience disparities in quality of life (QL) compared with Hispanic, African American, and white youth in the general population and to what extent socioeconomic status (SES) mediates any disparities among these racial/ethnic groups. Data were obtained from the Healthy Passages study, in which 4,972 Asian American (148; 3%), Hispanic (1,813; 36%), African American (1,755; 35%), and white (1,256; 25%) fifth-graders were enrolled in a population-based, cross-sectional survey conducted in three U.S. metropolitan areas. Youth reported their own QL using the PedsQL and supplemental scales. Parents reported youth’s overall health status as well as parent’s education and household income level. Asian American youth experienced worse status than white youth for three of 10 QL and well-being measures, better status than Hispanic youth on six measures, and better status than African American youth on three measures. ...
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Additional file 6. IRLM example 2: Hybrid Type II Effectiveness–Implementation Evaluation of a City-Wide HIV System Navigation Intervention in Chicago, IL
Additional file 7. IRLM example 3: Implementation, spread, and sustainment of Physical Therapy for Mild Parkinson's Disease through a Regional System of Care
Supplemental material, HEB876240_suppl_mat for Collective Avoidance of Social and Health Venues and HIV Racial Inequities: Network Modeling of Venue Avoidance on Venue Affiliation, Social Networks, and HIV Risk by Kayo Fujimoto, Peng... more
Supplemental material, HEB876240_suppl_mat for Collective Avoidance of Social and Health Venues and HIV Racial Inequities: Network Modeling of Venue Avoidance on Venue Affiliation, Social Networks, and HIV Risk by Kayo Fujimoto, Peng Wang, Dennis H. Li, Lisa M. Kuhns, Muhammad Amith and John A. Schneider in Health Education & Behavior
BackgroundYoung men who have sex with men are disproportionately impacted by the HIV epidemic in the United States. Few rigorously tested HIV prevention interventions have been developed for young men who have sex with men; previous... more
BackgroundYoung men who have sex with men are disproportionately impacted by the HIV epidemic in the United States. Few rigorously tested HIV prevention interventions have been developed for young men who have sex with men; previous interventions have primarily focused on in-person programming, with high variability in fidelity. With nearly all young men who have sex with men going online daily, eHealth approaches to prevention may successfully bridge research and practice. Keep It Up! is an eHealth HIV Prevention program for young men who have sex with men. Previous research has demonstrated its effectiveness in reducing sexually transmitted infections and condomless anal sex and efficiency in delivering HIV prevention education. Aim 1 is to compare two strategies for implementing KIU—implementation in community-based organizations and a centralized direct-to-consumer recruitment arm. Aim 2 is to examine adoption characteristics which explain variability in implementation success. ...
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Additional file 2. IRLM for Comparative Implementation
Additional file 4. IRLM for an Implementation Optimization Study
Additional file 5. IRLM example 1: Faith in Action: Clergy and Community Health Center Communication Strategies for Ending the Epidemic in Mississippi and Arkansas
Additional file 9. IRLM Worksheets
Additional file 1. IRLM Fillable PDF form
Additional file 8. IRLM Quick Reference Guide
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Additional file 3. IRLM for Implementation of an Intervention Across or Linking Two Contexts
Background Numerous models, frameworks, and theories exist for specific aspects of implementation research, including for determinants, strategies, and outcomes. However, implementation research projects often fail to provide a coherent... more
Background Numerous models, frameworks, and theories exist for specific aspects of implementation research, including for determinants, strategies, and outcomes. However, implementation research projects often fail to provide a coherent rationale or justification for how these aspects are selected and tested in relation to one another. Despite this need to better specify the conceptual linkages between the core elements involved in projects, few tools or methods have been developed to aid in this task. The Implementation Research Logic Model (IRLM) was created for this purpose and to enhance the rigor and transparency of describing the often-complex processes of improving the adoption of evidence-based interventions in healthcare delivery systems. Methods The IRLM structure and guiding principles were developed through a series of preliminary activities with multiple investigators representing diverse implementation research projects in terms of contexts, research designs, and imple...
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BACKGROUND Adolescent men who have sex with men (AMSM), aged 13 to 18 years, account for more than 80% of teen HIV occurrences. Despite this disproportionate burden, there is a conspicuous lack of evidence-based HIV prevention programs.... more
BACKGROUND Adolescent men who have sex with men (AMSM), aged 13 to 18 years, account for more than 80% of teen HIV occurrences. Despite this disproportionate burden, there is a conspicuous lack of evidence-based HIV prevention programs. Implementation issues are critical as traditional HIV prevention delivery channels (eg, community-based organizations, schools) have significant access limitations for AMSM. As such, eHealth interventions, such as our proposed SMART program, represent an excellent modality for delivering AMSM-specific intervention material where youth are. OBJECTIVE This randomized trial aimed to test the effectiveness of the SMART program in reducing condom-less anal sex and increasing condom self-efficacy, condom use intentions, and HIV testing for AMSM. We also plan to test whether SMART has differential effectiveness across important subgroups of AMSM based on race and ethnicity, urban versus rural residence, age, socioeconomic status, and participation in an Eng...
Many younger Black men who have sex with men (YBMSM) are exposed to homonegativity, societal stigma, and racial discrimination in their social environment. This study uses a social network modeling methodology to identify aspects of the... more
Many younger Black men who have sex with men (YBMSM) are exposed to homonegativity, societal stigma, and racial discrimination in their social environment. This study uses a social network modeling methodology to identify aspects of the social environment that are not often described, that is, the places and spaces or “venues” where YBMSM socialize or where they receive HIV prevention services. In particular, we identify the structural features of avoidance of these venues as an indicator of negative experiences, using bipartite exponential random graph models. Our study theorizes that YBMSM avoid certain venues en masse through information diffusion among social network members. We specify two social mechanisms of collective venue avoidance—(1) homophily (i.e., ego–alter similarity in venue avoidance) and (2) popular opinion leaders (as early adopters)—and test the corresponding hypotheses that (Hypothesis 1) socially connected individuals avoid venues together and that (Hypothesis...
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In 2019, the requisite biomedical and behavioral interventions to eliminate new HIV infections exist. “Ending the HIV Epidemic” now becomes primarily a challenge of will and implementation. This review maps the extent to which... more
In 2019, the requisite biomedical and behavioral interventions to eliminate new HIV infections exist. “Ending the HIV Epidemic” now becomes primarily a challenge of will and implementation. This review maps the extent to which implementation research (IR) has been integrated into HIV research by reviewing the recent funding portfolio of the NIH. We searched NIH RePORTER for HIV and IR-related research projects funded from January 2013 to March 2018. The 4629 unique studies identified were screened using machine learning and manual methods. 216 abstracts met the eligibility criteria of HIV and IR. Key study characteristics were then abstracted. NIH currently funds HIV studies that are either formally IR (n = 109) or preparatory for IR (n = 107). Few (13%) projects mentioned a guiding implementation model, theory, or framework, and only 56% of all studies explicitly mentioned measuring an implementation outcome. Considering the study aims along an IR continuum, 18 (8%) studies examine...
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People who identify as non-monosexual and transgender experience disparities in engagement with healthcare services relative to monosexual and cisgender persons, respectively. However, little is known about the healthcare utilization of... more
People who identify as non-monosexual and transgender experience disparities in engagement with healthcare services relative to monosexual and cisgender persons, respectively. However, little is known about the healthcare utilization of those with intersecting sexual and gender minority identities. We explored the knowledge, attitudes, and health motivation of non-monosexually identified transgender participants regarding preventive care and access to sexual healthcare services. We surveyed 87 ciswomen, 34 transwomen, and 27 transmen, all of whom identified as bisexual, pansexual, or queer (bi+). We assessed their access to health care, health outcome experiences, confidence with talking about anogenital topics, proactivity toward their health, comfort with healthcare providers, and knowledge about HPV and examined differences across groups. The data indicated that bi+ transmen and transwomen were more likely to be uninsured or on a government-sponsored insurance plan relative to bi...
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We introduce a new venue-informed network degree measure, which we applied to respondent-driven sampling (RDS) estimators. Using data collected from 746 young MSM in 2014-2016 in Chicago, IL, and Houston, TX, we estimated the population... more
We introduce a new venue-informed network degree measure, which we applied to respondent-driven sampling (RDS) estimators. Using data collected from 746 young MSM in 2014-2016 in Chicago, IL, and Houston, TX, we estimated the population seroprevalence of HIV and syphilis and risk/protective behaviors, using RDS estimates with self-reported network size as a standard degree measure as well as our proposed venue-informed degree measure. The results indicate that the venue-informed degree measure tended to be more efficient (smaller variance) and less biased than the other measure in both cities sampled. Venue attendance-adjusted network size may provide a more reliable and accurate degree measure for RDS estimates of the outcomes of interest.
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Geosocial networking applications (e.g., "hookup apps") are widely used among adult men who have sex with men (MSM). Little is known about adolescent MSM's (AMSM) use of these apps. Exploratory research is needed as... more
Geosocial networking applications (e.g., "hookup apps") are widely used among adult men who have sex with men (MSM). Little is known about adolescent MSM's (AMSM) use of these apps. Exploratory research is needed as AMSM's app use poses various ethical, legal, and sexual health concerns. This article examined AMSM's app use patterns and its associations with their sexual health and behavior. Two hundred sexually experienced AMSM in the United States (M age = 16.6, 49% racial/ethnic minority) completed online survey questions assessing their use of apps specific to MSM and not specific to MSM to meet partners for dating and sex, as well as their sexual behavior and HIV risk. Overall, 52.5% of participants (n = 105) reported using MSM-specific apps to meet partners for sex. Of these, most participants reported having oral (75.7%, n = 78) and anal sex (62.1%, n = 64) with those partners. Of those who reported having anal sex, 78.1% (n = 50) had sex with those part...
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Sexual minority adolescents (SMA) may be at disproportionate risk for misusing prescription psychotropic medications compared to their heterosexual peers. However, generalizable studies specific to this age group are lacking. The current... more
Sexual minority adolescents (SMA) may be at disproportionate risk for misusing prescription psychotropic medications compared to their heterosexual peers. However, generalizable studies specific to this age group are lacking. The current study aimed to describe the prevalence of sexual orientation disparities in prescription drug misuse among a nationally representative sample of adolescents as well as to examine key correlates of misuse. Using data from the National Youth Risk Behavior Survey, we conducted stepwise multivariable weighted logistic regressions, sequentially controlling for demographics, experiences of victimization, mental health, and other illicit substance use. Adjusting for grade and race/ethnicity, female SMA and gay and unsure males had significantly elevated odds of ever misusing a prescription drug compared to heterosexual adolescents (ORs from 1.7-2.5). Most sexual orientation disparities among females remained significant with the addition of victimization a...
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On December 11, 2013, the Indian Supreme Court recriminalized non-peno-vaginal sex under Sec. 377 of the Indian Penal Code (IPC), overturning a 2009 ruling that deemed IPC Sec. 377 unconstitutional. Similar "sodomy... more
On December 11, 2013, the Indian Supreme Court recriminalized non-peno-vaginal sex under Sec. 377 of the Indian Penal Code (IPC), overturning a 2009 ruling that deemed IPC Sec. 377 unconstitutional. Similar "sodomy laws" in other countries have been associated with increased violence, harassment, and other discrimination against men who have sex with men (MSM) and transgender women. However, few studies have looked at the effects of such a law in an Indian context. This study examined experiences of victimization among MSM and hijra/transgender women (MSM-H) in the State of Maharashtra using a mixed-method approach. Data came from a quantitative survey and qualitative focus groups and interviews from an HIV prevention study as well as qualitative media and case reports from a local MSM-H-serving community-based organization. MSM-H in Maharashtra reported experiencing a high frequency of harassment, violence, and extortion, particularly from male sex partners met online and police. IPC Sec. 377 was implicated across qualitative sources as creating a culture of protection for harassment against MSM-H by being used directly as a tool for harassment, hindering victims of harassment from seeking legal recourse, and adversely impacting HIV and healthcare services. The reinstated IPC Sec. 377 may directly and indirectly facilitate negative health outcomes among MSM-H. Health agencies and advocates should continue to monitor the impact of IPC Sec. 377, incorporate rights-based approaches to protect MSM-H identities while addressing their health and well-being, and explore avenues to initiate discussions with the government to work toward repealing the law.