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Arvidsson A, Grander A, Lindroth M. School health-care team members' reflections of their promotion of sexual and reproductive health and rights (SRHR): Important but neglected. SEXUAL & REPRODUCTIVE HEALTHCARE 2024; 39:100950. [PMID: 38335840 DOI: 10.1016/j.srhc.2024.100950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/25/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE Young people are prioritized regarding the promotion and safeguarding of sexual and reproductive health and rights - SRHR. In Sweden, the school is seen as an important arena with members of the school health-care or SHC team as vital actors in this work. This study explored SRHR-related work in SHC teams in Sweden. METHODS Within an explorative qualitative design, structured interviews were conducted with 33 nurses, counsellors, SHC unit managers and headmasters. Reflexive thematic analysis was applied, and two main themes found. RESULTS SHC team members see SRHR as an urgent topic, but address it only 'when necessary', not systematically - and they experience a shortage of guidance and cooperation regarding SRHR-related work. Even in a country with agreement on the importance of SRHR for all and on providing holistic comprehensive sex education in schools, young people are left to chance - i.e., to the SRHR competence in the professionals they meet. CONCLUSION SHC team members in Sweden see SRHR as an urgent topic but do not address it systematically. Moreover, they experience a shortage of guidance for their work. To avoid any professional stress of conscience and for equitable school health care regarding SRHR to be realized, research-informed policy needs to underline systematic, comparable and proactive practice.
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Affiliation(s)
- Anna Arvidsson
- Faculty of Health and Society, Department of Social Work, Centre for Sexology and Sexuality Studies, Malmö University, Malmö, Sweden
| | - Anette Grander
- The Swedish Association for Sexuality Education, RFSU, Malmö, Sweden
| | - Malin Lindroth
- Faculty of Health and Society, Department of Social Work, Centre for Sexology and Sexuality Studies, Malmö University, Malmö, Sweden; Department of Behavioural Science, Oslo Metropolitan University, Oslo, Norway.
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2
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Dannis J, Jenuwine S, Jones N, LaChance J, Hanna-Attisha M. Child Mental Health Status in Flint, Michigan: A Worsening Health Inequity, 2018-2022. Am J Public Health 2023; 113:1318-1321. [PMID: 37708425 PMCID: PMC10632840 DOI: 10.2105/ajph.2023.307406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2023] [Indexed: 09/16/2023]
Abstract
Objectives. To determine the burden of mental health disorders among children enrolled in Michigan's Flint Registry in the context of a local public health crisis and a nationally declared pediatric mental health crisis. Methods. This survey-based study included 1203 children aged 3 to 17 years whose caregivers enrolled them in the Flint Registry between December 2018 and March 2020 and who completed a follow-up survey between October 2020 and March 2022. The baseline and follow-up surveys included caregiver reports of childhood anxiety and depression and overall mental health wellness. Results. At enrollment, Flint Registry caregivers reported significantly higher rates of anxiety and depression among their children than caregivers reported nationally (12.9% vs 9.4% and 8.2% vs 4.4%; P < .001). Flint Registry caregivers also reported declines in their children's overall mental health wellness at follow-up, t(1472) = -4.17; P < .001. Conclusions. Our findings reveal a disparate burden of pediatric mental health disorders and exemplify the health inequities vulnerable populations face. Public Health Implications. More proactive and preventive steps should be taken to lessen this burden, especially in chronically disadvantaged communities that experience public health crises. (Am J Public Health. 2023;113(12):1318-1321. https://doi.org/10.2105/AJPH.2023.307406).
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Affiliation(s)
- Jacqueline Dannis
- The authors are with the Michigan State University-Hurley Children's Hospital Pediatric Public Health Initiative, Charles Stewart Mott Department of Public Health, Michigan State University College of Human Medicine, Flint
| | - Sarah Jenuwine
- The authors are with the Michigan State University-Hurley Children's Hospital Pediatric Public Health Initiative, Charles Stewart Mott Department of Public Health, Michigan State University College of Human Medicine, Flint
| | - Nicole Jones
- The authors are with the Michigan State University-Hurley Children's Hospital Pediatric Public Health Initiative, Charles Stewart Mott Department of Public Health, Michigan State University College of Human Medicine, Flint
| | - Jenny LaChance
- The authors are with the Michigan State University-Hurley Children's Hospital Pediatric Public Health Initiative, Charles Stewart Mott Department of Public Health, Michigan State University College of Human Medicine, Flint
| | - Mona Hanna-Attisha
- The authors are with the Michigan State University-Hurley Children's Hospital Pediatric Public Health Initiative, Charles Stewart Mott Department of Public Health, Michigan State University College of Human Medicine, Flint
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3
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Goldin Evans M, Wallace M, Theall KP, Mahoney AM, Richardson L, Daniel CM. State-Level Recommendations to Reduce Inequities in Sexually Transmitted Infections. Womens Health Issues 2022; 32:427-430. [PMID: 35961852 DOI: 10.1016/j.whi.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 07/05/2022] [Accepted: 07/15/2022] [Indexed: 10/15/2022]
Affiliation(s)
- Melissa Goldin Evans
- Mary Amelia Center for Women's Health Equity Research, Department of Social, Behavioral, and Population Science, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana.
| | - Maeve Wallace
- Mary Amelia Center for Women's Health Equity Research, Department of Social, Behavioral, and Population Science, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Katherine P Theall
- Mary Amelia Center for Women's Health Equity Research, Department of Social, Behavioral, and Population Science, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | | | - Lisa Richardson
- Institute of Women and Ethnic Studies, New Orleans, Louisiana
| | - Clare M Daniel
- Newcomb Institute, Tulane University, New Orleans, Louisiana
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Wilkins NJ, Rasberry C, Liddon N, Szucs LE, Johns M, Leonard S, Goss SJ, Oglesby H. Addressing HIV/Sexually Transmitted Diseases and Pregnancy Prevention Through Schools: An Approach for Strengthening Education, Health Services, and School Environments That Promote Adolescent Sexual Health and Well-Being. J Adolesc Health 2022; 70:540-549. [PMID: 35305791 PMCID: PMC9260911 DOI: 10.1016/j.jadohealth.2021.05.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/18/2020] [Accepted: 05/04/2021] [Indexed: 10/18/2022]
Abstract
Adolescents' health behaviors and experiences contribute to many outcomes, including risks for HIV, other sexually transmitted diseases, and unintended pregnancy. Public health interventions and approaches addressing risk behaviors or experiences in adolescence have the potential for wide-reaching impacts on sexual health and other related outcomes across the lifespan, and schools are a critical venue for such interventions. This paper describes a school-based program model developed by the Centers for Disease Control and Prevention's Division of Adolescent and School Health for preventing HIV/sexually transmitted diseases, unintended pregnancy, and related health risk behaviors and experiences among middle and high school students. This includes a summary of the theoretical and evidence base that inform the model, and a description of the model's activities, organized into three key strategies (sexual health education, sexual health services, and safe and supportive environments) and across three cross-cutting domains (strengthening staff capacity, increasing student access to programs and services, and engaging parent and community partners). The paper also outlines implications for adolescent health professionals and organizations working across schools, clinics, and communities, to address and promote adolescent sexual health and well-being.
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Affiliation(s)
- Natalie J. Wilkins
- Division of Adolescent and School Health National Center for HIV/AIDS, Hepatitis, STD and TB Prevention Centers for Disease Control and Prevention 1600 Clifton Road, MS US8-1 Atlanta, GA 30329,b Corresponding author: , 770-488-1392
| | - Catherine Rasberry
- Division of Adolescent and School Health National Center for HIV/AIDS, Hepatitis, STD and TB Prevention Centers for Disease Control and Prevention 1600 Clifton Road, MS US8-1 Atlanta, GA 30329
| | - Nicole Liddon
- Division of Adolescent and School Health National Center for HIV/AIDS, Hepatitis, STD and TB Prevention Centers for Disease Control and Prevention 1600 Clifton Road, MS US8-1 Atlanta, GA 30329
| | - Leigh E. Szucs
- Division of Adolescent and School Health National Center for HIV/AIDS, Hepatitis, STD and TB Prevention Centers for Disease Control and Prevention 1600 Clifton Road, MS US8-1 Atlanta, GA 30329
| | - Michelle Johns
- Division of Adolescent and School Health National Center for HIV/AIDS, Hepatitis, STD and TB Prevention Centers for Disease Control and Prevention 1600 Clifton Road, MS US8-1 Atlanta, GA 30329
| | - Sandra Leonard
- Division of Adolescent and School Health National Center for HIV/AIDS, Hepatitis, STD and TB Prevention Centers for Disease Control and Prevention 1600 Clifton Road, MS US8-1 Atlanta, GA 30329
| | - Sally J. Goss
- Division of Adolescent and School Health National Center for HIV/AIDS, Hepatitis, STD and TB Prevention Centers for Disease Control and Prevention 1600 Clifton Road, MS US8-1 Atlanta, GA 30329
| | - Heather Oglesby
- Division of Adolescent and School Health National Center for HIV/AIDS, Hepatitis, STD and TB Prevention Centers for Disease Control and Prevention 1600 Clifton Road, MS US8-1 Atlanta, GA 30329
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5
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Robin L, Timpe Z, Suarez NA, Li J, Barrios L, Ethier KA. Local Education Agency Impact on School Environments to Reduce Health Risk Behaviors and Experiences Among High School Students. J Adolesc Health 2022; 70:313-321. [PMID: 34531096 PMCID: PMC8792165 DOI: 10.1016/j.jadohealth.2021.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of the study is to assess associations between exposure to a multilevel, socio-ecological health program administered by local education agencies and changes in health behaviors among high school students. METHODS This analysis used a multilevel difference-in-differences approach to compare student health experiences and outcomes between schools selected by local education agencies nationwide to implement the program (exposed schools) and schools that were not (unexposed schools). We measured repeated cross-sectional outcomes using the 2015 and 2017 Youth Risk Behaviors Surveys. The final analytic sample comprised 638 schools in total (N = 64,838 students), with 237 exposed schools (n = 30,336 students) and 401 unexposed schools (n = 34,502 students). RESULTS Students in exposed schools demonstrated significant reduction in odds compared with those in unexposed schools in ever having sex (adjusted odds ratio [aOR] = .88, 95% confidence interval [CI]: .81-.96), having four or more lifetime sexual partners (aOR = .84, 95% CI: .72-.97), being currently sexually active (aOR = .78, 95% CI: .78-.96), and using effective hormonal birth control (aOR = .7, 95% CI: .56-.88). Exposure to the program was associated with significant reduction in odds of not going to school because of safety concerns (aOR = .87, 95% CI: .78-.97), having experienced forced sex (aOR = .76, 95% CI: .68-.86), ever used marijuana (aOR = .89, 95% CI: .81-.98), and currently using marijuana (aOR = .77, 95% CI: .64-.93). CONCLUSIONS Exposure to the program was associated with significant decreases in sexual risk behaviors, experience of violence, and substance use.
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Affiliation(s)
- Leah Robin
- Centers for Disease Control and Prevention, Division of Adolescent and School Health, Atlanta, Georgia.
| | - Zachary Timpe
- Centers for Disease Control and Prevention, Division of Adolescent and School Health, Atlanta, Georgia
| | - Nicolas A Suarez
- Centers for Disease Control and Prevention, Division of Adolescent and School Health, Atlanta, Georgia
| | - Jingjing Li
- Centers for Disease Control and Prevention, Division of Adolescent and School Health, Atlanta, Georgia
| | - Lisa Barrios
- Centers for Disease Control and Prevention, Division of Adolescent and School Health, Atlanta, Georgia
| | - Kathleen A Ethier
- Centers for Disease Control and Prevention, Division of Adolescent and School Health, Atlanta, Georgia
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6
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Wang LY, Peterson A, Li J, Coleman K, Dunville R. Cost-Effectiveness Analysis of Michigan's School-Wide Sexually Transmitted Disease Screening Program in Four Detroit High Schools. J Adolesc Health 2021; 69:957-963. [PMID: 34289955 PMCID: PMC9281505 DOI: 10.1016/j.jadohealth.2021.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 04/26/2021] [Accepted: 05/18/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE The Michigan Department of Health and Human Services, in collaboration with St. John Providence Health System, initiated voluntary school-wide sexually transmitted disease (STD) screenings in four Detroit public high schools. We sought to assess the cost-effectiveness of the STD screening program from 2010 to 2015, with a focus on chlamydia. METHODS The costs and effectiveness of the school-based screening were compared with those of a "no school screening" scenario using a healthcare system perspective. A decision tree model was constructed to project cases of chlamydia, epididymitis, and pelvic inflammatory disease (PID) in each of the two scenarios among students tested positive and their partners. Health effects were measured as cases of PID prevented, and quality-adjusted life-years (QALYs) gained. Cost estimates included program costs, chlamydia testing/treatment costs in the absence of school screening, and treatment costs for epididymitis, PID, and PID sequelae. The incremental cost-effectiveness ratio (ICER) was measured as cost/QALY gained. Multivariate sensitivity analyses were conducted on key parameter estimates and assumptions used. RESULTS Under base-case assumptions, at a total program cost of $333,848 over 5 years, the program prevented an estimated 1.9 cases of epididymitis and 17.3 cases of PID, resulting in an ICER of $38,235/QALY gained (yearly ICER ranging from $27,417 to $50,945/QALY). Of 10,000 Monte Carlo simulation runs, the yearly ICER remained ≤$50,000/QALY in 64%-98% of the simulation runs. CONCLUSIONS We found favorable cost-effectiveness ratios for Michigan's school-wide STD screening program in Detroit. School-based STD screening programs of this type warrant careful considerations by policy makers and program planners.
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Affiliation(s)
- Li Yan Wang
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Amy Peterson
- Division of HIV and STD Programs, Michigan Department of Health and Human Services, Detroit, Michigan
| | - Jingjing Li
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kenneth Coleman
- Ascension Southeast Michigan Community Health, Detroit, Michigan
| | - Richard Dunville
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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7
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Decker MJ, Dandekar S, Gutmann-Gonzalez A, Brindis CD. Bridging the Gap between Sexual Health Education and Clinical Services: Adolescent Perspectives and Recommendations. THE JOURNAL OF SCHOOL HEALTH 2021; 91:928-935. [PMID: 34523133 DOI: 10.1111/josh.13084] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/11/2021] [Accepted: 01/19/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Adolescents often lack access to accurate and appropriate sexual health information and services. Providing information about local clinical services during sexual health education classes is one strategy to increase awareness, yet many programs miss this opportunity. This study aims to learn about adolescents' experiences with sexual health education and their perceptions of barriers and facilitators to clinical care. METHODS Nine focus groups were conducted between April to July 2018 with 69 adolescents who had recently attended a comprehensive sexual health education program in California. Topics included information received about local clinics during class and barriers and facilitators to access care. Qualitative data were coded and analyzed for key themes and compared by sex and geographic location. RESULTS The majority of participants (89%) were Latino and most reported receiving relevant information about clinical services and had positive impressions of local services. Several mentioned that this information increased the likelihood that they would access services if needed. Common barriers to clinic services included parental disapproval, stigma, embarrassment, and confidentiality concerns. Facilitators included peer and family support, confidentiality of services, awareness and education, and accessibility. CONCLUSIONS Sexual health education programs can provide an important bridge to local clinic services and address adolescents' concerns.
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Affiliation(s)
- Martha J Decker
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th St 2nd floor, San Francisco, CA, 94158
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 490 Illinois St, San Francisco, CA, 94107
- Bixby Center for Global Reproductive Health, University of California San Francisco, 1001 Potrero Avenue, UCSF Box 0842, San Francisco, CA, 94110
| | - Shebani Dandekar
- Loma Linda University Health, 11234 Anderson Street, Loma Linda, CA, 92354
| | - Abigail Gutmann-Gonzalez
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 490 Illinois St, San Francisco, CA, 94107
- Bixby Center for Global Reproductive Health, University of California San Francisco, 1001 Potrero Avenue, UCSF Box 0842, San Francisco, CA, 94110
| | - Claire D Brindis
- Division Adolescent and Young Adult Health, Department of Obstetrics, Gynecology, and Reproductive Health Sciences, National Resource Center, University of California San Francisco, 3333 California Street, Suite 245, San Francisco, CA, 94118
- Emerita Director, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 490 Illinois St, San Francisco, CA, 94107
- Founding Director and Senior Scholar, Bixby Center for Global Reproductive Health, University of California San Francisco, 1001 Potrero Avenue, UCSF Box 0842, San Francisco, CA, 94110
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8
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Leichliter JS, Aral SO. Scientific and Programmatic Gaps in STD Prevention: A 2020 Assessment. Sex Transm Dis 2021; 48:S88-S89. [PMID: 33967235 PMCID: PMC8462797 DOI: 10.1097/olq.0000000000001449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Jami S Leichliter
- From the Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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Andrzejewski J, Pampati S, Johns MM, Sheremenko G, Lesesne C, Rasberry CN. Sexual Behaviors, Referral to Sexual Health Services, and Use of Sexual Health Services Among Transgender High School Students. THE JOURNAL OF SCHOOL HEALTH 2020; 90:349-357. [PMID: 32128830 PMCID: PMC8006206 DOI: 10.1111/josh.12880] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 03/13/2019] [Accepted: 06/23/2019] [Indexed: 05/06/2023]
Abstract
BACKGROUND Transgender adolescents are at increased risk for negative sexual health outcomes compared to their cisgender peers. METHODS Using data from 10,231 students from 7 high schools in a large, urban school district, our analysis compared sexual behaviors, referral to sexual health services by school staff, and use of sexual health services between transgender and cisgender students. We used propensity score matching to create a comparable sample of transgender and cisgender students and logistic regression models to examine how gender identity was associated with aforementioned outcomes. RESULTS Transgender students were more likely to have ever had sex, less likely to have used a condom at last sex, and more likely to have been referred for human immunodeficiency virus (HIV) testing, sexually transmitted disease (STD) testing, and other sexual health services than cisgender students. Transgender students were no more likely than cisgender students to have tested for HIV or STDs. CONCLUSIONS These findings underscore the need for understanding the risk perceptions held by transgender students and for prevention efforts that are inclusive for all gender identities. Research is needed to understand if school-based sexual health interventions such as staff referrals for sexual health services are effective for transgender students.
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Affiliation(s)
- Jack Andrzejewski
- ORISE Fellow, Oak Ridge Associated Universities, 1600 Clifton Road MS E-75, Atlanta, GA30329
| | - Sanjana Pampati
- ORISE Fellow, Oak Ridge Associated Universities, 1600 Clifton Road MS E-75, Atlanta, GA 30329
| | - Michelle M. Johns
- Health Scientist, US Centers for Disease Control and Prevention, Division of Adolescent and School Health, 1600 Clifton Road, MS E-75, Atlanta, GA 30329
| | - Ganna Sheremenko
- Lead Research Scientist, ICF, 2635 Century Center Parkway, Suite 1000, Atlanta GA 30345
| | - Catherine Lesesne
- Vice President, Research Science, ICF, 2635 Century Center Parkway, Suite 1000, Atlanta GA 30345
| | - Catherine N. Rasberry
- Health Scientist, US Centers for Disease Control and Prevention, Division of Adolescent and School Health, 1600 Clifton Road, MS E-75, Atlanta, GA 30329
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Leung E, Wanner KJ, Senter L, Brown A, Middleton D. What will it take? Using an implementation research framework to identify facilitators and barriers in implementing a school-based referral system for sexual health services. BMC Health Serv Res 2020; 20:292. [PMID: 32264884 PMCID: PMC7140539 DOI: 10.1186/s12913-020-05147-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 03/24/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Across the United States, sexually transmitted infections and unintended pregnancy rates are alarmingly high among youth. Schools, due to their proximity and access to youth, can increase student access to sexual health services (SHS) by creating referral systems (RS) to link students to school- and community-based SHS. From 2013 to 2018, the Centers for Disease Control and Prevention's Division of Adolescent and School Health funded 17 Local Education Agencies (LEA) to partner with priority schools and stakeholders to develop and implement RS to increase student access to SHS. Cicatelli Associates Inc. (CAI) was funded to provide capacity-building to LEA. In 2016-2017, CAI conducted case studies at two LEA, both large and urban sites, but representing different geographical and political contexts, to elucidate factors that influence RS implementation. METHODS Nineteen LEA and community-based healthcare (CBH) staff were interviewed in the Southeastern (n = 9) and Western U.S. (n = 10). Key constructs (e.g., leadership engagement, resources, state and district policies) across the five domains of the Consolidated Framework for Implementation Research (CFIR) framework guided the methodology and analysis. Qualitative data was analyzed using the Framework Method and contextual factors and themes that led to RS implementation were identified. RESULTS Interviewees strongly believed that school-based RS can decrease STI, HIV and unintended pregnancy and increase students' educational attainment. We identified the following contextual key factors that facilitate successful implementation and integration of an RS: enforcing state and district policies, strong LEA and CBH collaboration, positive school culture towards adolescent health, knowledgeable and supportive staff, leveraging of existing resources and staffing structures, and influential district and school building-level leadership and champions. Notably, this case study challenged our initial assumptions that RS are easily implemented in states with comprehensive SHS policies. Rather, our conversations revealed how districts and local-level policies can have significant impact and influence to impede or promote those policies. CONCLUSIONS Through the use of the CFIR framework, the interviews identified important contextual factors and themes associated with LEAs' implementation barriers and facilitators. The study's results present key recommendations that other LEA can consider to optimize integration of RS-related evidence-based practices, systems, and policies in their districts.
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Affiliation(s)
- Emily Leung
- Cicatelli Associates, Inc. (CAI), 505 Eighth Ave. Suite 1900, New York, NY 10018 USA
| | - Kathryn J. Wanner
- Franklin and Marshall College, College Square 931 Harrisburg Ave. 1st Floor, Lancaster, PA 17603 USA
| | - Lindsay Senter
- Cicatelli Associates, Inc. (CAI), 505 Eighth Ave. Suite 1900, New York, NY 10018 USA
| | - Amanda Brown
- Cicatelli Associates, Inc. (CAI), 505 Eighth Ave. Suite 1900, New York, NY 10018 USA
| | - Dawn Middleton
- Cicatelli Associates, Inc. (CAI), 505 Eighth Ave. Suite 1900, New York, NY 10018 USA
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Wang LY, Owusu-Edusei K, Parker JT, Wilson K. Cost-Effectiveness of a School-Based Chlamydia Screening Program, Duval County, FL. J Sch Nurs 2019; 37:195-201. [PMID: 31789096 DOI: 10.1177/1059840519890026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
During the 2015-2016 school year, the Florida Department of Health in Duval County hosted Teen Health Centers (TeenHC) at five high schools of Jacksonville providing HIV/STD screening and pregnancy testing. The purpose of this study was to assess the cost-effectiveness of the TeenHC chlamydia screening program and determine at what student participation level, the program can be cost-effective. We assessed the costs and effectiveness of the chlamydia screening program compared with "no TeenHC". Cost-effectiveness was measured as cost per quality-adjusted life years (QALY) gained. At a program cost of US$61,001 and 3% participation rate, the cost/QALY gained was $124,328 in the base-case analysis and $81,014-$264,271 in 95% of the simulation trials, all greater than the frequently citied $50,000/QALY benchmark. The cost/QALY gained could be <$50,000/QALY if student participation rate was >7%. The TeenHC chlamydia screening has the potential to be cost-effective. Future program efforts should focus on improving student participation.
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Affiliation(s)
- Li Yan Wang
- Division of Adolescent and School Health, 1242Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kwame Owusu-Edusei
- Program and Performance Improvement Office, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, 1242Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - J Terry Parker
- Division of Adolescent and School Health, 1242Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kristina Wilson
- Florida Department of Health in Duval County, Jacksonville, FL, USA
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Perin J, Jennings JM, Arrington-Sanders R, Page KR, Loosier PS, Dittus PJ, Marcell AV. Evaluation of an Adapted Project Connect Community-based Intervention Among Professionals Serving Young Minority Men. Sex Transm Dis 2019; 46:165-171. [PMID: 30652988 PMCID: PMC6631304 DOI: 10.1097/olq.0000000000000977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND To address sexual and reproductive health (SRH) needs of young minority urban males, we developed and evaluated Project Connect Baltimore (Connect), which was adapted from a program with demonstrated effectiveness among young females. The objectives were to determine (1) the feasibility of Connect as adapted for young minority men, (2) whether the program increased SRH knowledge and resource sharing of youth-serving professionals (YSPs) working with young men, and (3) whether the program improved awareness and use of resources for young minority men in Baltimore City, an urban environment with high rates of sexually transmitted diseases. METHODS Connect developed a clinic referral guide for male youth-friendly resources for SRH. The YSPs working with partners and organizations serving young minority men were trained to use Connect materials and pretraining, immediate, and 3-month posttraining surveys were conducted to evaluate program effects. A before-after evaluation study was conducted among young men attending five urban Connect clinics where sexually transmitted disease/human immunodeficiency virus rates are high, recruiting young men in repeated cross-sectional surveys from April 2014 to September 2017. RESULTS Two hundred thirty-five YSPs were trained to use Connect materials, including a website, an article-based pocket guide, and were given information regarding SRH for young men. These professionals demonstrated increased knowledge about SRH for young men at immediate posttest (60.6% to 86.7%, P < 0.05), and reported more sharing of websites for SRH (23% to 62%, P < 0.05) from pretraining to 3-month posttraining. 169 young minority men were surveyed and reported increased awareness of Connect over 3 and a half years (4% to 11%, P = 0.015), although few young men reported using the website to visit clinics. CONCLUSIONS Project Connect Baltimore increased knowledge of SRH needs among youth-serving professionals and sharing of SRH resources by these professionals with young men. This program also demonstrated increases in awareness of SRH resources among young minority urban men.
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Affiliation(s)
- Jamie Perin
- Johns Hopkins School of Public Health, Baltimore, MD
| | - Jacky M Jennings
- Johns Hopkins School of Public Health, Baltimore, MD
- Johns Hopkins School of Medicine, Baltimore, MD
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Brittain AW, Loyola Briceno AC, Pazol K, Zapata LB, Decker E, Rollison JM, Malcolm NM, Romero LM, Koumans EH. Youth-Friendly Family Planning Services for Young People: A Systematic Review Update. Am J Prev Med 2018; 55:725-735. [PMID: 30342635 PMCID: PMC6707512 DOI: 10.1016/j.amepre.2018.06.010] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/02/2018] [Accepted: 06/15/2018] [Indexed: 01/17/2023]
Abstract
CONTEXT Youth-friendly family planning services may improve youth reproductive health outcomes. A systematic review conducted in 2011 was updated in 2016 to incorporate recent data examining the effects of youth-friendly family planning services on reproductive health outcomes and the facilitators and barriers facing young people in accessing family planning services. EVIDENCE ACQUISITION PubMed, POPLINE, EMBASE, and other databases were used to identify relevant articles published from March 2011 through April 2016. EVIDENCE SYNTHESIS Eighteen studies met inclusion criteria and were added to 19 studies from the review conducted in 2011. Of these, seven assessed the effect of youth-friendly services on outcomes: two showed a positive effect on reducing teen pregnancy, three on contraceptive use, and three on knowledge and patient satisfaction (not mutually exclusive). Facilitators or barriers were described in 32 studies. However, none were RCTs and most were at high risk for bias due to selection, self-report, and recall bias among others. CONCLUSIONS The studies in this review suggest some positive effects of youth-friendly family planning services on reproductive health outcomes, but the need for more rigorous research persists. This review identified numerous factors relevant to young people's access to family planning services, reaffirming findings from the initial review: young people value confidentiality, supportive provider interaction, specialized provider training, and the removal of logistic barriers. Further, it illuminates the importance young people place on receiving comprehensive, client-centered family planning counseling. These findings should be considered when developing, implementing, and evaluating reproductive health services for young people. THEME INFORMATION This article is part of a theme issue entitled Updating the Systematic Reviews Used to Develop the U.S. Recommendations for Providing Quality Family Planning Services, which is sponsored by the Office of Population Affairs, U.S. Department of Health and Human Services.
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Affiliation(s)
- Anna W Brittain
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | | | - Karen Pazol
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lauren B Zapata
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Emily Decker
- Office of Population Affairs, HHS, Washington, District of Columbia
| | | | | | - Lisa M Romero
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Emilia H Koumans
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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Bonett S, Connochie D, Golinkoff JM, Horvath KJ, Bauermeister JA. Paradata Analysis of an eHealth HIV Testing Intervention for Young Men Who Have Sex With Men. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2018; 30:434-447. [PMID: 30332307 PMCID: PMC6449689 DOI: 10.1521/aeap.2018.30.5.434] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Little is known about users' intervention engagement and use patterns within eHealth interventions. We describe these patterns among young men who have sex with men (YMSM) who participated in a brief eHealth intervention designed to increase HIV testing. We merged pilot trial participants' survey data (N = 86) with their paradata (e.g., system data recorded during interaction with the intervention). We created engagement (time spent on components) and use (interaction with features) metrics, and explored whether they differed by participant characteristics. Racial/ethnic minorities clicked on fewer features (mean = 8.30) than non-Hispanic White men (mean = 12.00). Use was associated with older age (r = .19), greater educational attainment (r = .25), and a greater number of methods to connect online (r = .38). Paradata can help researchers understand how users interact with eHealth interventions, and inform which components to retain or redesign. Efforts to systematically collect, analyze, and report paradata in eHealth HIV prevention and care interventions are warranted.
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Affiliation(s)
- Stephen Bonett
- University of Pennsylvania, School of Nursing, Philadelphia, PA, United States
| | - Daniel Connochie
- University of Pennsylvania, School of Nursing, Philadelphia, PA, United States
| | - Jesse M Golinkoff
- University of Pennsylvania, School of Nursing, Philadelphia, PA, United States
| | - Keith J Horvath
- University of Minnesota, School of Public Health, Minneapolis, MN, United States
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Bauermeister JA, Golinkoff JM, Horvath KJ, Hightow-Weidman LB, Sullivan PS, Stephenson R. A Multilevel Tailored Web App-Based Intervention for Linking Young Men Who Have Sex With Men to Quality Care (Get Connected): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2018; 7:e10444. [PMID: 30072358 PMCID: PMC6096165 DOI: 10.2196/10444] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/07/2018] [Accepted: 05/08/2018] [Indexed: 01/22/2023] Open
Abstract
Background HIV epidemic among young men who have sex with men (YMSM) is characterized by strong racial disparities and concerns about the availability and access to culturally appropriate HIV prevention and care service delivery. Get Connected, a Web-based intervention that employs individual- and system-level tailoring technology to reduce barriers to HIV prevention care (eg, HIV or sexually transmitted infection [STI] testing, pre-exposure prophylaxis [PrEP]), was developed for YMSM (age 15-24 years). This protocol details the design and procedures of a 2-phase project that includes mystery shopping and a randomized controlled trial (RCT) to test the efficacy of Get Connected among YMSM in Philadelphia, Atlanta, and Houston. Objective The objective of mystery shopping is to examine the quality of HIV test counseling and PrEP-related referrals for YMSM within local HIV or STI testing sites. The objective of the RCT is to test the efficacy of Get Connected for increasing HIV-negative or HIV-unknown YMSM’s successful uptake of HIV prevention services (eg, routine HIV or STI testing), PrEP awareness, and likelihood to start PrEP (PrEP willingness), compared with those in the control condition, over a 12-month period. Methods For Phase 1, we will create a master list of HIV and STI testing sites in each city. We will enroll and train 10-15 mystery shoppers per city; each testing site will be separately visited and assessed by 2 mystery shoppers. After each site visit, the mystery shoppers will complete a site evaluation to record their perceptions of various measures including lesbian, gay, bisexual, transgender, queer visibility and inclusivity, privacy and confidentiality, provider-patient interactions, and clinic environment. For Phase 2, we will enroll 480 YMSM for 12 months across the 3 iTech cities into a 2-arm prospective RCT. Participants randomized to the control condition are directed to the AIDSVu.org testing site locator. Participants randomized to the intervention condition will be granted access to a Web app with content tailored to their specific demographic characteristics (eg, age, race or ethnicity, location, and relationship status), HIV and STI risk behaviors (eg, HIV and STI testing history, substance use, communication with partners regarding status) and sociocultural context (eg, homelessness, incarceration). Study assessments will occur at enrollment and at 1, 3, 6, 9, and 12 months postenrollment. Results Get Connected research activities began in September 2016 and are ongoing. To date, institutional review board (IRB) submission is complete and IRB authorization agreements are pending at several other universities. Conclusions The deployment of Get Connected through a mobile-optimized Web app seeks to optimize the intervention’s acceptability, accessibility, availability, and long-term affordability among YMSM. Trial Registration ClinicalTrials.gov (NCT03132415); https://clinicaltrials.gov/ct2/show/NCT03132415 (Archived by WebCite at http://www.webcitation.org/70j4gSFbZ) Registered Report Identifier RR1-10.2196/10444
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Affiliation(s)
- José A Bauermeister
- School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Jesse M Golinkoff
- School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Keith J Horvath
- School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Lisa B Hightow-Weidman
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Patrick S Sullivan
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Rob Stephenson
- School of Nursing and the Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, United States
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Hector J, Davies MA, Dekker-Boersema J, Aly MM, Abdalad CCA, Langa EBR, Ehmer J, Hobbins MA, Jefferys LF. Acceptability and performance of a directly assisted oral HIV self-testing intervention in adolescents in rural Mozambique. PLoS One 2018; 13:e0195391. [PMID: 29621308 PMCID: PMC5886533 DOI: 10.1371/journal.pone.0195391] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 03/21/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Whereas progress in HIV testing and treatment has been made globally, the UNAIDS goal of "90 90 90" is still out of sight in rural northern Mozambique. New strategies that promote testing in hard to reach groups will aid Mozambique's response to the HIV epidemic. HIV self-testing (HIVST) is recommended by the WHO as an additional approach to augment the HIV testing services available to adolescents. This study evaluates acceptability and performance of a directly assisted oral HIVST intervention for adolescents in rural Mozambique. METHODS Adolescents aged 16-20 years were included at schools and invited to attend the local hospital's youth friendly service for directly assisted oral HIVST. Baseline and post-test questionnaires were obtained. OraQuick Rapid HIV-1/2 Anti body test® was used. Results were read by the participant and by a nurse. Results were confirmed by finger prick HIV test (Determine® HIV 1/2 Alere and Unigold™ HIV Trinity Biotech) according to the Mozambican national standard. RESULTS Between September and November 2016, 496 adolescents were included, of which 299 performed an oral HIV self-test. 70% were first time testers. The positivity rate was 1.7%. The inter-rater agreement between adolescent and nurse was 99.6% (kappa 0.93); there were no false negative or false positive results of the oral HIV self-test. Five tests were invalid. 7.1% found the test difficult to use. Over 80% preferred directly assisted HIVST compared to the standard finger prick testing. While 20% thought it would be good to do HIVST at home, 76% preferred to do HIVST at the health centre, for reasons including increased security, privacy, and the presence of a counsellor. CONCLUSIONS Directly assisted oral HIVST is a feasible intervention for adolescents in rural Mozambique and showed encouraging results for first time HIV testers.
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Affiliation(s)
| | - Mary-Ann Davies
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Mussa Manuel Aly
- Operational Research Unit Pemba, Pemba, Cabo Delgado, Mozambique
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Affiliation(s)
- Carly E Guss
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts and Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
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18
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Dittus PJ, Harper CR, Becasen JS, Donatello RA, Ethier KA. Structural Intervention With School Nurses Increases Receipt of Sexual Health Care Among Male High School Students. J Adolesc Health 2018; 62:52-58. [PMID: 29102554 PMCID: PMC6739836 DOI: 10.1016/j.jadohealth.2017.07.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 07/20/2017] [Accepted: 07/20/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE Adolescent males are less likely to receive health care and have lower levels of sexual and reproductive health (SRH) knowledge than adolescent females. The purpose of this study was to determine if a school-based structural intervention focused on school nurses increases receipt of condoms and SRH information among male students. METHODS Interventions to improve student access to sexual and reproductive health care were implemented in six urban high schools with a matched set of comparison schools. Interventions included working with school nurses to improve access to sexual and reproductive health care, including the provision of condoms and information about pregnancy and sexually transmitted disease prevention and services. Intervention effects were assessed through five cross-sectional yearly surveys, and analyses include data from 13,740 male students. RESULTS Nurses in intervention schools changed their interactions with male students who visited them for services, such that, among those who reported they went to the school nurse for any reason in the previous year, those in intervention schools reported significant increases in receipt of sexual health services over the course of the study compared with students in comparison schools. Further, these results translated into population-level effects. Among all male students surveyed, those in intervention schools were more likely than those in comparison schools to report increases in receipt of sexual health services from school nurses. CONCLUSIONS With a minimal investment of resources, school nurses can become important sources of SRH information and condoms for male high school students.
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Affiliation(s)
- Patricia J Dittus
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Christopher R Harper
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Robin A Donatello
- Department of Mathematics & Statistics, California State University, Chico, Chico, California
| | - Kathleen A Ethier
- Office of the Director, Centers for Disease Control and Prevention, Atlanta, Georgia
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19
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Wang LY, Chang MH, Burstein G, Adkins SH. Human Immunodeficiency Virus, Chlamydia, and Gonorrhea Testing in New York Medicaid-Enrolled Adolescents. Sex Transm Dis 2018; 45:14-18. [PMID: 28876281 PMCID: PMC10658586 DOI: 10.1097/olq.0000000000000686] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although growing public health efforts have been expended on increasing adolescents' access to human immunodeficiency virus (HIV) and sexually transmitted infection (STI) testing, little is known about the current utilization of those services in clinical settings. METHODS Using 2010 to 2012 New York State Center for Medicare and Medicaid Services Medicaid Analytic eXtract data, we estimated the annual percentage of 13- to 19-year-olds who were tested for HIV, chlamydia (CT), and gonorrhea (GC). A regression analysis was performed to identify factors independently associated with testing utilization. We further examined testing utilization in all adolescent females with 1 or more health care encounter, pregnant females, and adolescents at increased risk for HIV/STI. RESULTS From 2010 to 2012, HIV, CT, and GC testing rates increased in the overall study population and in most demographic subgroups. Female adolescents, black and Hispanic adolescents, at-risk adolescents, and adolescents with 6 months or longer of enrollment were significantly more likely to be tested. Among adolescent females with 1 or more health care encounter, 19.2% were tested for CT and 16.9% tested for GC in 2012. Among pregnant females, 35.2%, 53.9%, and 46.1% were tested for HIV, CT, and GC, respectively. Among at-risk adolescents, 39.9%, 63.7%, and 54.4% were tested for HIV, CT, and GC, respectively. CONCLUSIONS Although progress had been made by New York State providers to adhere to recommended testing for adolescents, there was a clear gap between the recommended level of testing and the actual level of utilization among sexually active females, pregnant females, and at-risk adolescents. Opportunities exist for community provider and public health collaboration to increase adolescent HIV and STI testing.
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Affiliation(s)
- Li Yan Wang
- Centers for Disease Control and Prevention, Atlanta, GA
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20
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Abstract
AimThe aim of this study was to explore the role and activities of the school nursing service in sexual health within a large inner London borough. BACKGROUND School nurses (SNs) are specialist community public health nurses working with the school age population to promote their health and well-being and therefore are arguably in a prime position to promote the sexual health of children and young people. This is particularly pertinent in inner city boroughs where the rates of sexually transmitted infections and under-18 conceptions are a significant problem. METHODS Following a review of the literature, a mixed methods study was undertaken which included an audit of documentary data to identify the referrals received in relation to sexual health and also included questionnaire surveys of school staff and SNs on their views of the role of the SN in sexual health.FindingsSNs and school staff identified that SNs have a role in sexual health, which was reflected in the referrals received during the audit of documentary data. There appeared to be inconsistencies across the service and evidence suggested that the school nursing service may be underutilised in comparison to the number of students who require sexual health support. The current service appears to be predominantly reactive, particularly for males and those less than 12 years old. However, both SNs and school staff would like to see a more preventative approach; including greater sexual health promotion, condom distribution and school health clinics.
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Hogben M, Harper C, Habel MA, Brookmeyer K, Friedman A. Attitudes to sexual health in the United States: results from a national survey of youth aged 15-25 years. Sex Health 2017. [PMID: 28648149 DOI: 10.1071/sh16164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Several common global definitions of sexual health refer to physical, emotional and social well-being, with respect to sexuality, and also to the need for this well-being to be reflected for all individuals in relationships. How well sexual health definitions fit US youths' attitudes to sexual health, and associations between these attitudes, sexual behaviours and sexual health care were assessed. METHODS In total, 4017 youth aged between 15 and 25 years via an online survey panel, weighted to be representative of the US population, were surveyed. Respondents reported their attitudes towards seven dimensions of sexual health that we abstracted from existing global definitions (emotional fulfillment, social connectedness, spirituality, overall pleasure, physical intimacy, mental fulfillment, reciprocal benefits). Respondents also reported on sexual health-related discussions with partners, sexual behaviours, and their use of sexual health care. Outcomes through weighted frequency estimates and ordinal regression models were reported. RESULTS Youth generally construed all seven dimensions as important to sexual health, with the emotional dimension rated most favourably. Attitudes to the dimensions of overall pleasure, physical intimacy and spirituality were most consistently related to sexual health discussions and behaviours. The behaviours most consistently related to sexual health attitudes were going for a sexual health check-up, discussing birth control/pregnancy and discussing risk before sex without a condom. CONCLUSIONS Youth construal of sexual health fits well with global sexual health definitions. Attitudes to dimensions of sexual health were related to some sexual health-related behaviours, especially healthcare use and complex discussions.
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Affiliation(s)
- Matthew Hogben
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30030, USA
| | - Christopher Harper
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA 30030, USA
| | - Melissa A Habel
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30030, USA
| | - Kathryn Brookmeyer
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30030, USA
| | - Allison Friedman
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA 30030, USA
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Morris E, Topete P, Rasberry CN, Lesesne CA, Kroupa E, Carver L. School-Based HIV/STD Testing Behaviors and Motivations Among Black and Hispanic Teen MSM: Results From a Formative Evaluation. THE JOURNAL OF SCHOOL HEALTH 2016; 86:888-897. [PMID: 27866390 PMCID: PMC5921839 DOI: 10.1111/josh.12457] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 03/30/2016] [Accepted: 04/01/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND This evaluation explores experiences with, and motivations for, human immunodeficiency virus (HIV) and sexually transmitted disease (STD) testing among black and Hispanic school-aged young men who have sex with men (YMSM). METHODS Participants were recruited at community-based organizations that serve YMSM in New York City, Philadelphia, and San Francisco. Eligible participants were 13- to 19-year-old black or Hispanic males who reported attraction to or sexual behavior with other males and/or identified as gay or bisexual, and attended at least 90 days of school in the previous 18 months. Participants (N = 415) completed web-based questionnaires and/or in-depth interviews (N = 32). RESULTS In the past year, 72.0% of questionnaire participants had been tested for HIV, 13.5% of them at school or school clinic. Participants reported that they would be more likely to get an HIV test if they could be tested close to or at school (34.4%), and 64.4% would use HIV testing if offered in schools. Most interview participants reported willingness to use school-based services if they were offered nonjudgmentally, privately, and confidentially by providers with experience serving YMSM. CONCLUSION Schools can provide opportunities to make HIV and STD testing accessible to school-aged YMSM, but the services must be provided in ways that are comfortable to them.
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Affiliation(s)
- Elana Morris
- Behavioral Scientist, Division of HIV Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-75, Atlanta, GA 30329
| | - Pablo Topete
- Technical Specialist, ICF International, 3 Corporate Square, Suite 370, Atlanta, GA 30329
| | - Catherine N. Rasberry
- Health Scientist, Division of Adolescent and School Health, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-75, Atlanta, GA 30329
| | - Catherine A. Lesesne
- Technical Director, ICF International, 3 Corporate Square, Suite 370, Atlanta, GA 30329
| | - Elizabeth Kroupa
- Manager, ICF International, 710 Second Avenue, Suite 550, Seattle, WA 98104
| | - Lisa Carver
- Manager, ICF International, 3 Corporate Square, Suite 370, Atlanta, GA 30329
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Mason‐Jones AJ, Sinclair D, Mathews C, Kagee A, Hillman A, Lombard C. School-based interventions for preventing HIV, sexually transmitted infections, and pregnancy in adolescents. Cochrane Database Syst Rev 2016; 11:CD006417. [PMID: 27824221 PMCID: PMC5461872 DOI: 10.1002/14651858.cd006417.pub3] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND School-based sexual and reproductive health programmes are widely accepted as an approach to reducing high-risk sexual behaviour among adolescents. Many studies and systematic reviews have concentrated on measuring effects on knowledge or self-reported behaviour rather than biological outcomes, such as pregnancy or prevalence of sexually transmitted infections (STIs). OBJECTIVES To evaluate the effects of school-based sexual and reproductive health programmes on sexually transmitted infections (such as HIV, herpes simplex virus, and syphilis), and pregnancy among adolescents. SEARCH METHODS We searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) for published peer-reviewed journal articles; and ClinicalTrials.gov and the World Health Organization's (WHO) International Clinical Trials Registry Platform for prospective trials; AIDS Educaton and Global Information System (AEGIS) and National Library of Medicine (NLM) gateway for conference presentations; and the Centers for Disease Control and Prevention (CDC), UNAIDS, the WHO and the National Health Service (NHS) centre for Reviews and Dissemination (CRD) websites from 1990 to 7 April 2016. We handsearched the reference lists of all relevant papers. SELECTION CRITERIA We included randomized controlled trials (RCTs), both individually randomized and cluster-randomized, that evaluated school-based programmes aimed at improving the sexual and reproductive health of adolescents. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion, evaluated risk of bias, and extracted data. When appropriate, we obtained summary measures of treatment effect through a random-effects meta-analysis and we reported them using risk ratios (RR) with 95% confidence intervals (CIs). We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS We included eight cluster-RCTs that enrolled 55,157 participants. Five trials were conducted in sub-Saharan Africa (Malawi, South Africa, Tanzania, Zimbabwe, and Kenya), one in Latin America (Chile), and two in Europe (England and Scotland). Sexual and reproductive health educational programmesSix trials evaluated school-based educational interventions.In these trials, the educational programmes evaluated had no demonstrable effect on the prevalence of HIV (RR 1.03, 95% CI 0.80 to 1.32, three trials; 14,163 participants; low certainty evidence), or other STIs (herpes simplex virus prevalence: RR 1.04, 95% CI 0.94 to 1.15; three trials, 17,445 participants; moderate certainty evidence; syphilis prevalence: RR 0.81, 95% CI 0.47 to 1.39; one trial, 6977 participants; low certainty evidence). There was also no apparent effect on the number of young women who were pregnant at the end of the trial (RR 0.99, 95% CI 0.84 to 1.16; three trials, 8280 participants; moderate certainty evidence). Material or monetary incentive-based programmes to promote school attendanceTwo trials evaluated incentive-based programmes to promote school attendance.In these two trials, the incentives used had no demonstrable effect on HIV prevalence (RR 1.23, 95% CI 0.51 to 2.96; two trials, 3805 participants; low certainty evidence). Compared to controls, the prevalence of herpes simplex virus infection was lower in young women receiving a monthly cash incentive to stay in school (RR 0.30, 95% CI 0.11 to 0.85), but not in young people given free school uniforms (Data not pooled, two trials, 7229 participants; very low certainty evidence). One trial evaluated the effects on syphilis and the prevalence was too low to detect or exclude effects confidently (RR 0.41, 95% CI 0.05 to 3.27; one trial, 1291 participants; very low certainty evidence). However, the number of young women who were pregnant at the end of the trial was lower among those who received incentives (RR 0.76, 95% CI 0.58 to 0.99; two trials, 4200 participants; low certainty evidence). Combined educational and incentive-based programmesThe single trial that evaluated free school uniforms also included a trial arm in which participants received both uniforms and a programme of sexual and reproductive education. In this trial arm herpes simplex virus infection was reduced (RR 0.82, 95% CI 0.68 to 0.99; one trial, 5899 participants; low certainty evidence), predominantly in young women, but no effect was detected for HIV or pregnancy (low certainty evidence). AUTHORS' CONCLUSIONS There is a continued need to provide health services to adolescents that include contraceptive choices and condoms and that involve them in the design of services. Schools may be a good place in which to provide these services. There is little evidence that educational curriculum-based programmes alone are effective in improving sexual and reproductive health outcomes for adolescents. Incentive-based interventions that focus on keeping young people in secondary school may reduce adolescent pregnancy but further trials are needed to confirm this.
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Affiliation(s)
- Amanda J Mason‐Jones
- University of YorkDepartment of Health SciencesSeebohm Rowntree Building, HeslingtonYorkUKYO10 5DD
- University of Cape TownDepartment of Psychiatry and Mental HealthCape TownSouth Africa
- University of StellenboschInterdisciplinary Health SciencesCape TownSouth Africa
| | - David Sinclair
- Liverpool School of Tropical MedicineDepartment of Clinical SciencesPembroke PlaceLiverpoolUKL3 5QA
| | - Catherine Mathews
- South African Medical Research CouncilHealth Systems Research UnitPO Box 19070TygerbergCape TownSouth Africa7505
- University of Cape TownSchool of Public Health and Family MedicineRondeboschCape TownSouth Africa7700
| | - Ashraf Kagee
- Stellenbosch UniversityDepartment of PsychologyPrivate Bag X1MatielandWestern CapeSouth Africa7602
| | - Alex Hillman
- University of YorkDepartment of Health SciencesSeebohm Rowntree Building, HeslingtonYorkUKYO10 5DD
| | - Carl Lombard
- South African Medical Research CouncilBiostatistics UnitCape TownSouth Africa
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Kingori C, Esquivel CL, Hassan Q, Elmi A, Mukasa B, Reece M. Recommendations for Developing Contextually Relevant HIV/AIDS Prevention Strategies Targeting African-Born Immigrants and Refugees in the United States. AIDS Patient Care STDS 2016; 30:476-483. [PMID: 27749109 DOI: 10.1089/apc.2016.0171] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
African-born immigrants and refugees have HIV infection rates six times higher than any other minority groups in the United States. Despite the increase in the population size and diversity of Somali immigrants and refugees in the United States, Somalis are one of the medically underserved population subgroups in this region. The lack of aggregate HIV infection rates among African-born immigrants, for example, Somali refugees, is a cause for alarm and calls for more research to be conducted in this subgroup. The purpose of this article was to examine contextually relevant HIV prevention strategies that will enhance HIV prevention among Somali immigrant/refugee young adults in the United States. Using the grounded theory approach, a convenience sample of 27 immigrant/refugee young adults was recruited in central Ohio. Recommendations for potential HIV prevention strategies emerged under two main categories: (1) internal community resources and (2) external platforms. Study findings support a collaborative approach involving community leaders (parents, elders, religious leaders) and educational (schools), media, and healthcare settings to tailor HIV prevention strategies that meet the needs of the priority group.
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Affiliation(s)
- Caroline Kingori
- 1 Department of Social and Public Health, Grover Center W347, Ohio University , Athens, Ohio
| | | | - Qorsho Hassan
- 3 Dwight Schar College of Education, Ashland University , Columbus, Ohio
| | - Abdul Elmi
- 4 Luitpold Pharmaceutical , Canal Winchester, Ohio
| | - Bakali Mukasa
- 5 Alexandria Elite Consulting Group, Inc. , Everett, Massachusetts
| | - Michael Reece
- 6 Applied Health Science, School of Public Health, Indiana University-Bloomington , Bloomington, Indiana
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Habel MA, Becasen JS, Kachur R, Eastman-Mueller H, Dittus PJ. Community Colleges: Rethinking STD Prevention for the Nontraditional College Campus. COMMUNITY COLLEGE JOURNAL OF RESEARCH AND PRACTICE 2016; 4:747-756. [PMID: 32063697 PMCID: PMC7020619 DOI: 10.1080/10668926.2016.1220874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
As increased attention and proposed funding are being directed toward community colleges, it is important to consider the sexual and reproductive health care needs of this growing population. Existing data suggest there are significant sexual health needs among this population and often insufficient provision of services. Some community college students are more likely than students at 4-year colleges to test positive for sexually transmitted diseases (STDs). Given resource constraints, creative solutions are required. These may include campus-wide policies addressing STD/HIV (human immunodeficiency virus) prevention, referral systems to connect students to care in the community, and partnerships with local health departments, Federally Qualified Health Centers, or community-based organizations to assist with the provision of services. Colleges have the unique opportunity to provide students with valuable information about sexual health and services. Community colleges, in particular, are uniquely positioned to reach at-risk community members for STD testing and sexual health care who might otherwise be lost to care. More research is needed on the sexual health needs of community college students, especially on factors such as geographic location, how embedded the school is into the community, social norms around sexual health on college campuses, and health services offered. New and innovative ways to promote linkage to care for testing and counseling could offer potential health benefits to this growing at-risk population.
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Affiliation(s)
- Melissa A. Habel
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jeffrey S. Becasen
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rachel Kachur
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Patricia J. Dittus
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Loosier PS, Doll S, Lepar D, Ward K, Gamble G, Dittus PJ. Effectiveness of an Adaptation of the Project Connect Health Systems Intervention: Youth and Clinic-Level Findings. THE JOURNAL OF SCHOOL HEALTH 2016; 86:595-603. [PMID: 27374349 PMCID: PMC10150609 DOI: 10.1111/josh.12414] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 01/21/2016] [Accepted: 03/30/2016] [Indexed: 05/03/2023]
Abstract
BACKGROUND The Project Connect Health Systems Intervention (Project Connect) uses a systematic process of collecting community and healthcare infrastructure information to craft a referral guide highlighting local healthcare providers who provide high quality sexual and reproductive healthcare. Previous self-report data on healthcare usage indicated Project Connect was successful with sexually experienced female youth, where it increased rates of human immunodeficiency virus (HIV) and sexually transmitted disease (STD) testing and receipt of contraception. This adaption of Project Connect examined its effectiveness in a new context and via collection of clinic encounter-level data. METHODS Project Connect was implemented in 3 high schools. (only 2 schools remained open throughout the entire project period). Participant recruitment and data collection occurred in 5 of 8 participating health clinics. Students completed Youth Surveys (N = 608) and a Clinic Survey (paired with medical data abstraction in 2 clinics [N = 305]). RESULTS Students were more likely than nonstudents to report having reached a clinic via Project Connect. Nearly 40% of students attended a Project Connect school, with 32.7% using Project Connect to reach the clinic. Students were most likely to have been referred by a school nurse or coach. CONCLUSIONS Project Connect is a low-cost, sustainable structural intervention with multiple applications within schools, either as a standalone intervention or in combination with ongoing efforts.
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Affiliation(s)
- Penny S Loosier
- Centers for Disease Control and Prevention, 1600 Clifton Road, MS-E02, Atlanta, GA 30333.
| | - Shelli Doll
- HIV Care and Prevention Section, Michigan Department of Health and Human Services, Lansing, MI 48913.
| | - Danielle Lepar
- Center for Data Management and Translational Research, Michigan Public Health Institute, Okemos, MI 48864.
| | - Kristin Ward
- Center for Data Management and Translational Research, Michigan Public Health Institute, Okemos, MI 48864.
| | - Ginger Gamble
- Center for Data Management and Translational Research, Michigan Public Health Institute, Okemos, MI 48864.
| | - Patricia J Dittus
- Centers for Disease Control and Prevention, 1600 Clifton Road, MS-E44, Atlanta, GA 30333.
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Rasberry CN, Liddon N, Adkins SH, Lesesne CA, Hebert A, Kroupa E, Rose ID, Morris E. The Importance of School Staff Referrals and Follow-Up in Connecting High School Students to HIV and STD Testing. J Sch Nurs 2016; 33:143-153. [PMID: 27418443 DOI: 10.1177/1059840516658695] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study examined predictors of having received HIV and sexually transmitted disease (STD) testing and having been referred by school staff for HIV/STD testing. In 2014, students in seven high schools completed paper-and-pencil questionnaires assessing demographic characteristics, sexual behavior, referrals for HIV/STD testing, and HIV/STD testing. The analytic sample ( n = 11,303) was 50.7% female, 40.7% Hispanic/Latino, 34.7% Black/African American (non-Hispanic), and mean age was 15.86 ( SD = 1.22). After controlling for demographic characteristics, significant predictors of reporting having been tested for HIV or STDs were reporting having received a referral for HIV/STD testing (odds ratio [ OR] = 3.18; 95% CI = [2.14, 4.70]) and reporting staff following-up on the referral ( OR = 3.29; 95% CI = [1.31, 8.23]). Students reporting referrals had significantly higher odds of being male ( OR = 2.49; 95% CI = [1.70, 3.65]), "other" or multiracial (non-Hispanic; compared to White, non-Hispanic; OR = 2.72; 95% CI = [1.35, 5.46]), sexual minority ( OR = 3.80; 95% CI = [2.57, 5.62]), and sexually experienced ( OR = 2.58; 95% CI = [1.76, 3.795]). School staff referrals with follow-up may increase HIV/STD testing among students.
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Affiliation(s)
- Catherine N Rasberry
- 1 Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nicole Liddon
- 1 Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Susan Hocevar Adkins
- 1 Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | | | | | - Elana Morris
- 4 Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Garfield CF, Duncan G, Peters S, Rutsohn J, McDade TW, Adam EK, Coley RL, Chase-Lansdale PL. Adolescent Reproductive Knowledge, Attitudes, and Beliefs and Future Fatherhood. J Adolesc Health 2016; 58:497-503. [PMID: 26896211 PMCID: PMC5052073 DOI: 10.1016/j.jadohealth.2015.12.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 12/19/2015] [Accepted: 12/21/2015] [Indexed: 11/17/2022]
Abstract
PURPOSE With a growing focus on the importance of men's reproductive health, including preconception health, the ways in which young men's knowledge, attitudes, and beliefs (KAB) predict their reproductive paths are understudied. To determine if reproductive KAB predicts fatherhood status, timing and residency (living with child or not). METHODS Reproductive KAB and fatherhood outcomes were analyzed from the National Longitudinal Study of Adolescent Health, a 20-year, nationally representative study of individuals from adolescence into adulthood. Four measures of reproductive KAB were assessed during adolescence in waves I and II. A generalized linear latent and mixed model predicted future fatherhood status (nonfather, resident/nonresident father, adolescent father) and timing while controlling for other socio-demographic variables. RESULTS Of the 10,253 men, 3,425 were fathers (686 nonresident/2,739 resident) by wave IV. Higher risky sexual behavior scores significantly increased the odds of becoming nonresident father (odds ratio [OR], 1.30; p < .0001), resident father (OR, 1.07; p = .007), and adolescent father (OR, 1.71; p < .0001); higher pregnancy attitudes scores significantly increased the odds of becoming a nonresident father (OR, 1.20; p < .0001) and resident father (OR, 1.11; p < .0001); higher birth control self-efficacy scores significantly decreased the odds of becoming a nonresident father (OR, .72; p < .0001) and adolescent father (OR, .56; p = .01). CONCLUSIONS Young men's KAB in adolescence predicts their future fatherhood and residency status. Strategies that address adolescent males' reproductive KAB are needed in the prevention of unintended reproductive consequences such as early and nonresident fatherhood.
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Affiliation(s)
- Craig F Garfield
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Institute for Policy Research, Northwestern University, Evanston, Illinois.
| | - Greg Duncan
- School of Education, University of California-Irvine, Irvine, California
| | - Sarah Peters
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Joshua Rutsohn
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Thomas W McDade
- Institute for Policy Research, Northwestern University, Evanston, Illinois; Department of Anthropology, Northwestern University, Evanston, Illinois
| | - Emma K Adam
- Institute for Policy Research, Northwestern University, Evanston, Illinois; School of Education and Social Policy, Northwestern University, Evanston, Illinois
| | | | - Patricia Lindsay Chase-Lansdale
- Institute for Policy Research, Northwestern University, Evanston, Illinois; School of Education and Social Policy, Northwestern University, Evanston, Illinois
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Koenig LJ, Hoyer D, Purcell DW, Zaza S, Mermin J. Young People and HIV: A Call to Action. Am J Public Health 2016; 106:402-5. [PMID: 26794156 PMCID: PMC4815747 DOI: 10.2105/ajph.2015.302979] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2015] [Indexed: 11/04/2022]
Abstract
HIV is having a significant impact on young people, among whom the rate of new diagnoses is high and health disparities are more pronounced. Incidence is increasing among young gay and bisexual men, and, among Black males, the largest percentage of new infections occur among those aged between 13 and 24 years. Youths are least likely to experience the health and prevention benefits of treatment. Nearly half of young people with HIV are not diagnosed; among those diagnosed, nearly a quarter are not linked to care, and three quarters are not virally suppressed. Addressing this burden will require renewed efforts to implement effective prevention strategies across multiple sectors, including educational, social, policy, and health care systems that influence prevention knowledge, service use, and treatment options for youths.
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Affiliation(s)
- Linda J Koenig
- Linda J. Koenig and David W. Purcell are with the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Deborah Hoyer is with the Office of Disease Prevention and Health Promotion, US Department of Health and Human Services, Rockville, MD. Stephanie Zaza is with the Division of Adolescent and School Health, Centers for Disease Control and Prevention. Jonathan Mermin is with the National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention
| | - Deborah Hoyer
- Linda J. Koenig and David W. Purcell are with the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Deborah Hoyer is with the Office of Disease Prevention and Health Promotion, US Department of Health and Human Services, Rockville, MD. Stephanie Zaza is with the Division of Adolescent and School Health, Centers for Disease Control and Prevention. Jonathan Mermin is with the National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention
| | - David W Purcell
- Linda J. Koenig and David W. Purcell are with the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Deborah Hoyer is with the Office of Disease Prevention and Health Promotion, US Department of Health and Human Services, Rockville, MD. Stephanie Zaza is with the Division of Adolescent and School Health, Centers for Disease Control and Prevention. Jonathan Mermin is with the National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention
| | - Stephanie Zaza
- Linda J. Koenig and David W. Purcell are with the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Deborah Hoyer is with the Office of Disease Prevention and Health Promotion, US Department of Health and Human Services, Rockville, MD. Stephanie Zaza is with the Division of Adolescent and School Health, Centers for Disease Control and Prevention. Jonathan Mermin is with the National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention
| | - Jonathan Mermin
- Linda J. Koenig and David W. Purcell are with the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Deborah Hoyer is with the Office of Disease Prevention and Health Promotion, US Department of Health and Human Services, Rockville, MD. Stephanie Zaza is with the Division of Adolescent and School Health, Centers for Disease Control and Prevention. Jonathan Mermin is with the National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention
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Romero LM, Middleton D, Mueller T, Avellino L, Hallum-Montes R. Improving the Implementation of Evidence-Based Clinical Practices in Adolescent Reproductive Health Care Services. J Adolesc Health 2015; 57:488-95. [PMID: 26381918 PMCID: PMC4624029 DOI: 10.1016/j.jadohealth.2015.07.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 07/23/2015] [Accepted: 07/23/2015] [Indexed: 11/16/2022]
Abstract
PURPOSE The purposes of the study were to describe baseline data in the implementation of evidence-based clinical practices among health center partners as part of a community-wide teen pregnancy prevention initiative and to identify opportunities for health center improvement. METHODS Health center partner baseline data were collected in the first year (2011) and before program implementation of a 5-year community-wide teen pregnancy prevention initiative. A needs assessment on health center capacity and implementation of evidence-based clinical practices was administered with 51 health centers partners in 10 communities in the United States with high rates of teen pregnancy. RESULTS Health centers reported inconsistent implementation of evidence-based clinical practices in providing reproductive health services to adolescents. Approximately 94.1% offered same-day appointments, 91.1% had infrastructure to reduce cost barriers, 90.2% offered after-school appointments, and 80.4% prescribed hormonal contraception without prerequisite examinations or testing. Approximately three quarters provided visual and audio privacy in examination rooms (76.5%) and counseling areas (74.5%). Fewer offered a wide range of contraceptive methods (67.8%) and took a sexual health history at every visit (54.9%). Only 45.1% reported Quick Start initiation of hormonal contraception, emergency contraception (43.1%), or intrauterine devices (12.5%) were "always" available to adolescents. CONCLUSIONS The assessment highlighted opportunities for health center improvement. Strategies to build capacity of health center partners to implement evidence-based clinical practices may lead to accessibility and quality of reproductive health services for adolescents in the funded communities.
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Affiliation(s)
- Lisa M Romero
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | | | - Trisha Mueller
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lia Avellino
- Cicatelli Associates, Inc. (CAI), New York, New York
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31
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Bauermeister JA, Pingel ES, Jadwin-Cakmak L, Harper GW, Horvath K, Weiss G, Dittus P. Acceptability and preliminary efficacy of a tailored online HIV/STI testing intervention for young men who have sex with men: the Get Connected! program. AIDS Behav 2015; 19:1860-74. [PMID: 25638038 DOI: 10.1007/s10461-015-1009-y] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Southeast Michigan accounts for over 70 % of all HIV/STI cases in the state, with young men who have sex with men (YMSM) between the ages of 13 and 24 encumbering the largest burden in HIV/STI incidence. Using community-based participatory research principles, we developed and pilot tested a web-based, randomized control trial seeking to promote HIV/STI testing ("Get Connected!") among YMSM (N = 130; ages 15-24). Randomized participants completed a baseline assessment and shown a test-locator condition (control) or a tailored, personalized site (treatment). At 30-day follow-up, we found high acceptability among YMSM in both conditions, yet higher credibility of intervention content among YMSM in the treatment group (d = .55). Furthermore, 30 participants reported testing by following, with the majority of these participants (73.3 %; n = 22) completing the treatment condition, a clinically meaningful effect (d = .34) suggesting preliminary efficacy for the intervention. These results demonstrate the potential of the intervention, and suggest that a larger efficacy trial may be warranted.
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Affiliation(s)
- José A Bauermeister
- Center for Sexuality and Health Disparities, Department of Health Behavior & Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, SPH I Room 3822, Ann Arbor, MI, 48109-2029, USA.
| | - Emily S Pingel
- Center for Sexuality and Health Disparities, Department of Health Behavior & Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, SPH I Room 3822, Ann Arbor, MI, 48109-2029, USA
| | - Laura Jadwin-Cakmak
- Center for Sexuality and Health Disparities, Department of Health Behavior & Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, SPH I Room 3822, Ann Arbor, MI, 48109-2029, USA
| | - Gary W Harper
- Center for Sexuality and Health Disparities, Department of Health Behavior & Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, SPH I Room 3822, Ann Arbor, MI, 48109-2029, USA
| | | | - Gretchen Weiss
- National Association of County and City Health Officials (NACCHO), Washington, DC, USA
| | - Patricia Dittus
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Bauermeister JA, Pingel ES, Jadwin-Cakmak L, Harper GW, Horvath K, Weiss G, Dittus P. Acceptability and preliminary efficacy of a tailored online HIV/STI testing intervention for young men who have sex with men: the Get Connected! program. AIDS Behav 2015. [PMID: 25638038 DOI: 10.1007/sl0461-015-1009-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Southeast Michigan accounts for over 70 % of all HIV/STI cases in the state, with young men who have sex with men (YMSM) between the ages of 13 and 24 encumbering the largest burden in HIV/STI incidence. Using community-based participatory research principles, we developed and pilot tested a web-based, randomized control trial seeking to promote HIV/STI testing ("Get Connected!") among YMSM (N = 130; ages 15-24). Randomized participants completed a baseline assessment and shown a test-locator condition (control) or a tailored, personalized site (treatment). At 30-day follow-up, we found high acceptability among YMSM in both conditions, yet higher credibility of intervention content among YMSM in the treatment group (d = .55). Furthermore, 30 participants reported testing by following, with the majority of these participants (73.3 %; n = 22) completing the treatment condition, a clinically meaningful effect (d = .34) suggesting preliminary efficacy for the intervention. These results demonstrate the potential of the intervention, and suggest that a larger efficacy trial may be warranted.
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Affiliation(s)
- José A Bauermeister
- Center for Sexuality and Health Disparities, Department of Health Behavior & Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, SPH I Room 3822, Ann Arbor, MI, 48109-2029, USA.
| | - Emily S Pingel
- Center for Sexuality and Health Disparities, Department of Health Behavior & Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, SPH I Room 3822, Ann Arbor, MI, 48109-2029, USA
| | - Laura Jadwin-Cakmak
- Center for Sexuality and Health Disparities, Department of Health Behavior & Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, SPH I Room 3822, Ann Arbor, MI, 48109-2029, USA
| | - Gary W Harper
- Center for Sexuality and Health Disparities, Department of Health Behavior & Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, SPH I Room 3822, Ann Arbor, MI, 48109-2029, USA
| | | | - Gretchen Weiss
- National Association of County and City Health Officials (NACCHO), Washington, DC, USA
| | - Patricia Dittus
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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