Viviendo entre dos culturas: Evaluating the psychometric properties of the Psychological Acculturation Scale among Latinx caregivers.

More than 19 million individuals of reproductive potential in the United States live in communities with limited access to comprehensive sexual and reproductive health (SRH) care []. Adolescents and young adults account for nearly half of the estimated 26 million incident sexually transmitted infections (STIs) occurring annually in the United States [], and many pregnancies in this age group are unintended [,]. These risks are compounded in rural communities, where young adults face fewer SRH clinicians per capita, reduced continuity of care, and privacy constraints inherent to close-knit communities [,-]. When clinical care is inaccessible, rural young adults increasingly seek SRH information through digital platforms. In one analysis of YouTube birth control videos, roughly 40% of reproductive health content was identified as inaccurate or misleading []. This problem is compounded by health data poverty: the systematic underrepresentation of rural populations in the datasets used to train AI systems. This data gap degrades the performance and cultural relevance of digital health tools for the communities that need them the most [,]. At the same time, rural communities often exhibit lower baseline trust in institutional systems and emerging technologies, a skepticism that is often historically justified, yet existing AI health tool development has overwhelmingly treated trust as a postdeployment outcome to measure rather than as a foundational design input [,]. AI-enabled conversational health tools, commonly referred to as chatbots, hold promise for addressing rural SRH information gaps. These tools can deliver personalized, confidential, on-demand health guidance at scale without requiring a clinical appointment, transportation, or disclosure of one’s identity to community members [,-]. For sensitive health domains in which stigma and social judgment may inhibit care seeking, this combination of accessibility and anonymity is particularly valuable.