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Seetharaman S, Matson PA, Trent ME, McCartney Swamy A, Marcell AV. Association of Adolescents' Body Mass Index Classification With Preventive Clinical Care Receipt. J Adolesc Health 2023; 73:1046-1052. [PMID: 37690010 PMCID: PMC10841196 DOI: 10.1016/j.jadohealth.2023.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 05/28/2023] [Accepted: 06/26/2023] [Indexed: 09/11/2023]
Abstract
PURPOSE To examine differences in screening and advising for modifiable risk behaviors during well-visits based on adolescents' body mass index categories. METHODS Retrospective analyses were conducted with the National Institute of Health's NEXT Generation Health Study data, a nationally representative cohort of 10th graders. In wave 1 (2010), adolescents were classified as being underweight (<4.99th percentile), normal-weight (5-84.99th percentile), overweight (85-94.99th percentile), or with obesity (≥95th percentile) based on the body mass index categories described by the Centers for Disease Control and Prevention. In wave 2 (2011), adolescents were asked by their provider about smoking, alcohol use, use of other drugs, sexual activity, nutrition, and exercise, and whether they were advised about risks associated with these behaviors. RESULTS The sample consisted of 1,639 eligible participants as follows: 57.8% females, 63.3% 16-year-olds, 47.8% non-Hispanic Whites, 41.5% living in the South, 75.4% with health insurance, and 29.8% with low family affluence. Screening rates for overweight compared to normal-weight males were 51% reduced for smoking, 46% for alcohol use, 47% for other drug use, 57% for nutrition, and 47% for exercise. Screening rates were 40% reduced for other drug use for males with obesity, and 89% reduced for alcohol use for underweight males compared to normal-weight males. Advice receipt for females with obesity compared to normal-weight females was 90% increased for nutrition and 78% increased for exercise. DISCUSSION Overweight male adolescents reported being less likely to be screened across almost all preventive service topics representing missed opportunities for care delivery.
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Affiliation(s)
- Sujatha Seetharaman
- Division of Pediatric Endocrinology, The Warren Alpert School of Medicine of Brown University, Providence, Rhode Island.
| | - Pamela A Matson
- Division of Adolescent and Young Adult Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Maria E Trent
- Division of Adolescent and Young Adult Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Annemarie McCartney Swamy
- Division of Adolescent and Young Adult Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Arik V Marcell
- Division of Adolescent and Young Adult Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
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Graves L, Leung S, Raghavendran P, Mennito S. Transitions of Care for Healthy Young Adults: Promoting Primary Care and Preventive Health. South Med J 2019; 112:497-499. [PMID: 31485590 DOI: 10.14423/smj.0000000000001017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The transition of care between pediatric and adult medicine is a challenging time for patients and physicians. This longitudinal process encompasses much more than the physical transfer of a patient between providers. Established transition of care processes and literature exist for many chronic disease populations, but little focus has been directed toward the transition of care and the delivery of preventive medicine for healthy young adult patients. The 18- to 30-year-old age group is a heterogenous population that often engages in high-risk behaviors and has high rates of preventable morbidity and mortality. A significant number of these patients do not receive routine primary care and are high users of costly emergency services. Without a continuous source of care, many young adults do not receive age-appropriate screening or preventive health guidance. Structured transition practices improve outcomes in the chronic disease population, and anticipatory guidance has a positive effect on patient lifestyle modification. Adult providers should use these practices to ensure the successful integration of healthy young adult patients into an adult medical home. By establishing an ongoing source of preventive care, providers could reduce morbidity and mortality in this vulnerable population.
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Affiliation(s)
- Laurie Graves
- From the Departments of Internal Medicine and Pediatrics, Medical University of South Carolina, Charleston
| | - Shannon Leung
- From the Departments of Internal Medicine and Pediatrics, Medical University of South Carolina, Charleston
| | - Prashant Raghavendran
- From the Departments of Internal Medicine and Pediatrics, Medical University of South Carolina, Charleston
| | - Sarah Mennito
- From the Departments of Internal Medicine and Pediatrics, Medical University of South Carolina, Charleston
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Moseley CA, Vulimiri M, Saunders RS, Bleser WK, Perrin EM, Armstrong SC, Wang GX, Ubel PA, McClellan M, Wong CA. Medicaid and CHIP Child Health Beneficiary Incentives: Program Landscape and Stakeholder Insights. Pediatrics 2019; 144:peds.2018-3161. [PMID: 31289193 PMCID: PMC6855824 DOI: 10.1542/peds.2018-3161] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/06/2019] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To describe the landscape of Medicaid and the Children's Health Insurance Program beneficiary incentive programs for child health and garner key stakeholder insights on incentive program rationale, child and family engagement, and program evaluation. METHODS We identified beneficiary health incentive programs from 2005 to 2018 through a search of peer-reviewed and publicly available documents and through semistructured interviews with 80 key stakeholders (Medicaid and managed-care leadership, program evaluators, patient advocates, etc). This study highlights insights from 23 of these stakeholders with expertise on programs targeting child health (<18 years old) to understand program rationale, beneficiary engagement, and program evaluation. RESULTS We identified 82 child health-targeted beneficiary incentive programs in Medicaid and the Children's Health Insurance Program. Programs most commonly incentivized well-child checks (n = 77), preventive screenings (n = 30), and chronic disease management (n = 30). All programs included financial incentives (eg, gift cards, premium incentives); some also offered incentive material prizes (n = 12; eg, car seats). Loss-framed incentives were uncommon (n = 1; eg, lost benefits) and strongly discouraged by stakeholders. Stakeholders suggested family engagement strategies including multigenerational incentives or incentives addressing social determinants of health. Regarding evaluation, stakeholders suggested incentivizing evidence-based preventive services (eg, vaccinations) rather than well-child check attendance, and considering proximal measures of child well-being (eg, school functioning). CONCLUSIONS As the landscape of beneficiary incentive programs for child health evolves, policy makers have unique opportunities to leverage intergenerational and social approaches for family engagement and to more effectively increase and evaluate programs' impact.
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Affiliation(s)
- Connor A. Moseley
- Department of Pediatrics, School of Medicine,,Robert J. Margolis, MD, Center for Health Policy, Duke University, Durham, North Carolina
| | - Madhulika Vulimiri
- Sanford School of Public Policy, and,Robert J. Margolis, MD, Center for Health Policy, Duke University, Durham, North Carolina
| | - Robert S. Saunders
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Durham, North Carolina
| | - William K. Bleser
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Durham, North Carolina
| | - Eliana M. Perrin
- Department of Pediatrics, School of Medicine,,Duke Center for Childhood Obesity Research, Durham, North Carolina; and
| | - Sarah C. Armstrong
- Department of Pediatrics, School of Medicine,,Duke Center for Childhood Obesity Research, Durham, North Carolina; and,Duke Clinical Research Institute, Durham, North Carolina
| | - Gary X. Wang
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Durham, North Carolina
| | | | - Mark McClellan
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Durham, North Carolina
| | - Charlene A. Wong
- Department of Pediatrics, School of Medicine,,Sanford School of Public Policy, and,Robert J. Margolis, MD, Center for Health Policy, Duke University, Durham, North Carolina;,Duke Center for Childhood Obesity Research, Durham, North Carolina; and,Duke Clinical Research Institute, Durham, North Carolina
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Santelli JS, Klein JD, Song X, Heitel J, Grilo S, Wang M, Yan H, Kaseeska K, Gorzkowski J, Schneider M, Dereix AE, Catallozzi M. Discussion of Potentially Sensitive Topics With Young People. Pediatrics 2019; 143:peds.2018-1403. [PMID: 30651304 DOI: 10.1542/peds.2018-1403] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To identify modifiable factors that facilitate discussion of potentially sensitive topics between health care providers and young people at preventive service visits after Patient Protection and Affordable Care Act implementation. METHODS We used data from a national internet survey of adolescents and young adults (13-26 years old) in the United States. Questionnaire construction was guided by formative research and Fisher's Information-Motivation-Behavioral Skills model. Those who had seen a regular health care provider in the past 2 years were asked about 11 specific topics recommended by national medical guidelines. Four multivariable regression models were used to identify independent predictors of discussions of (1) tobacco use, (2) drug and/or alcohol use, (3) sexually transmitted infections or HIV, and (4) the number of topics discussed. RESULTS Fewer than half of young people reported having discussed 10 of 11 topics at their last visit. Predictors were similar across all 4 models. Factors independently associated with health discussions included the following: ever talked with a provider about confidentiality (4/4 models; adjusted odds ratio [aOR] = 1.85-2.00), ever had private time with a provider (1 model; aOR = 1.50), use of health checklist and/or screening questionnaire at last visit (4 models; aOR = 1.78-1.96), and time spent with provider during last visit (4 models). Number of years that young men had seen their regular provider was significant in 1 model. Other independent factors were positive youth attitudes about discussing specific topics (3/3 models) and youth involvement in specific health risk behaviors (3/3 models). CONCLUSIONS Discussions about potentially sensitive topics between health care providers and young people are associated with modifiable factors of health care delivery, particularly provider explanations of confidentiality, use of screening and/or trigger questionnaires, and amount of time spent with their provider.
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Affiliation(s)
- John S Santelli
- Heilbrunn Department of Population and Family Health, .,Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Jonathan D Klein
- Department of Pediatrics, College of Medicine, University of Illinois, Chicago, Illinois.,Julius B. Richmond Center of Excellence, American Academy of Pediatrics, Itasca, Illinois
| | - Xiaoyu Song
- Department of Population Health Science and Policy, and.,The Tisch Cancer Institute, Icahn School of Medicine, Mount Sinai, New York, New York; and
| | | | | | - Mengru Wang
- Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | - Hanying Yan
- Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | - Kristen Kaseeska
- Julius B. Richmond Center of Excellence, American Academy of Pediatrics, Itasca, Illinois
| | - Julie Gorzkowski
- Julius B. Richmond Center of Excellence, American Academy of Pediatrics, Itasca, Illinois
| | | | | | - Marina Catallozzi
- Heilbrunn Department of Population and Family Health.,Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York.,Morgan Stanley Children's Hospital, New York-Presbyterian Hospital, New York, New York
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