Invited Commentary: Broadening the Evidence for Adolescent Sexual and Reproductive Health and Education in the United States

Scientific research has made major contributions to adolescent health by providing insights into factors that influence it and by defining ways to improve it. However, US adolescent sexual and reproductive health policies—particularly sexuality health education policies and programs—have not benefited from the full scope of scientific understanding. From 1998 to 2009, federal funding for sexuality education focused almost exclusively on ineffective and scientifically inaccurate abstinence-only-until-marriage (AOUM) programs. Since 2010, the largest source of federal funding for sexual health education has been the “tier 1” funding of the Office of Adolescent Health’s Teen Pregnancy Prevention Initiative. To be eligible for such funds, public and private entities must choose from a list of 35 programs that have been designated as “evidence-based” interventions (EBIs), determined based on their effectiveness at preventing teen pregnancies, reducing sexually transmitted infections, or reducing rates of sexual risk behaviors (i.e., sexual activity, contraceptive use, or number of partners). Although the transition from primarily AOUM to EBI is important progress, this definition of evidence is narrow and ignores factors known to play key roles in adolescent sexual and reproductive health. Important bodies of evidence are not treated as part of the essential evidence base, including research on lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) youth; gender; and economic inequalities and health. These bodies of evidence underscore the need for sexual health education to approach adolescent sexuality holistically, to be inclusive of all youth, and to address and mitigate the impact of structural inequities. We provide recommendations to improve US sexual health education and to strengthen the translation of science into programs and policy.     

How Managers Can Reduce Household Water Use Through Communication: A Field Experiment

As populations increase and droughts intensify, water providers are using tools such as persuasive messaging to decrease residential water use. However, district-led messaging campaigns are rarely informed by psychological science, evaluated for effectiveness, or strategically disseminated. In collaboration with a water district, we report a field experiment among single-family households using persuasive messaging based on the information-motivation-behavioral skills model (IMB). We randomly assigned 10,000 households to receive different mailings and measured household water use. All messaging reduced water consumption relative to the control. On average, water use dropped 0.68 hundred cubic feet (HCF) (509 gallons) per household in the first month. Had all 10,000 single-family, occupied, non-agricultural residences been mailed the IMB messaging, more than five million gallons would have been saved in the first month. The effects declined but persisted for approximately three months and were three to six times greater in households with high water use (75th to 90th percentiles) relative to average water use. These findings suggest that combining message elements from the IMB model can reduce residential water use and that targeting high-use households is particularly cost-effective.     

Parent Perceptions of Participating in a Program for Adolescents Who Are Violent at Home

Child-to-parent abuse (CPA) is an under-addressed form of family violence and relatively few resources are available for families experiencing CPA. The Step-Up program is a CPA-specific, family-level, group format intervention program in King County, Washington. Qualitative and long-term research on CPA intervention programs is lacking, and it is unknown how parents perceive the effects of participating in Step-Up after program completion. Fifteen parents who completed Step-Up with their adolescent child participated in individual semi-structured telephone or in-person interviews. Participants were asked about their perceptions of the effects of Step-Up participation, how they and their child have used skills taught in the program, and which program features were most and least effective. Participants expressed largely positive effects of participating in Step-Up, including decreased violent behavior by their adolescents and improved parent-child relationships. Recommendations for improving Step-Up included the inclusion of follow-up sessions to further reinforce behavior change and increased program accessibility.     

4F‐MDMB‐BINACA: A New Synthetic Cannabinoid Widely Implicated in Forensic Casework

This is the first report regarding the characterization of the new synthetic cannabinoid 4F‐MDMB‐BINACA. 4F‐MDMB‐BINACA was first analytically confirmed in seized drug material using gas chromatography–mass spectrometry (GC‐MS), liquid chromatography–quadrupole time‐of‐flight mass spectrometry (LC‐QTOF), and nuclear magnetic resonance (NMR) spectroscopy. Subsequent to this characterization, 4F‐MDMB‐BINACA was detected in biological specimens collected as part of forensically relevant casework, including medicolegal death investigations and drug impaired driving investigations, from a variety of regions in the United States. Further analysis of biological specimens resulted in the identification of the metabolites 4F‐MDMB‐BINACA 3,3‐dimethylbutanoic acid and 4‐OH‐MDMB‐BINACA. 4F‐MDMB‐BINACA is appearing with increasing frequency as a contributory factor in deaths, creating morbidity and mortality risks for drug users. Laboratories must be aware of its presence and impact, incorporating 4F‐MDMB‐BINACA into workflows for detection and confirmation.