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Embleton L, Boal A, Sawakar S, Chory A, Bandanapudi RM, Patel T, Levinson C, Vreeman R, Wu WJ, Diaz A, Ott MA. Characterizing models of adolescent and youth-friendly health services in sub-Saharan Africa: a scoping review. Int J Adolesc Med Health 2024; 36:203-236. [PMID: 38838271 DOI: 10.1515/ijamh-2024-0001] [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: 01/02/2024] [Accepted: 05/24/2024] [Indexed: 06/07/2024]
Abstract
This scoping review provides an up-to-date overview of the evidence on adolescent and youth-friendly health services (AYFHS) in sub-Saharan African countries. We conducted a search of four databases and grey literature sources to identify English language publications from January 1, 2005, to December 14th, 2022. The review synthesized evidence on the models and characteristics of AYFHS, the application of World Health Organization (WHO) standards, and whether AYFHS have improved young people's health outcomes. In total, 77 sources were included in the review, representing 47 AYFHS initiatives spanning 19 countries, and three multi-country reports. Most commonly, AYFHS were delivered in public health facilities and focused on sexual and reproductive health, with limited application of WHO standards. Some evidence suggested that AYFHS increased young people's health service utilization and contraceptives uptake. There is a clear need to strengthen and develop innovative and multi-pronged approaches to delivering and evaluating AYFHS in this region.
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Affiliation(s)
- Lonnie Embleton
- Department of Global Health and Health System Design, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ava Boal
- Department of Global Health and Health System Design, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sakshi Sawakar
- Department of Global Health and Health System Design, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ashley Chory
- Department of Global Health and Health System Design, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Riya Murty Bandanapudi
- Graduate School of Biomedical Sciences at Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tirth Patel
- Graduate School of Biomedical Sciences at Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Carrie Levinson
- Levy Library, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rachel Vreeman
- Department of Global Health and Health System Design, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Wan-Ju Wu
- Department of Global Health and Health System Design, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Angela Diaz
- Department of Global Health and Health System Design, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mary A Ott
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
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Itriyeva K. Improving Health Equity and Outcomes for Children and Adolescents: The Role of School-Based Health Centers (SBHCs). Curr Probl Pediatr Adolesc Health Care 2024; 54:101582. [PMID: 38490819 DOI: 10.1016/j.cppeds.2024.101582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
School-based health centers (SBHCs) provide a critical point of access to youth in low-resource communities. By providing a combination of primary care, reproductive health, mental health, vision, dental, and nutrition services, SBHCs improve the health, wellbeing, and academic achievement of the students they serve. SBHCs operate in collaboration with schools and community primary care providers to optimize the management of chronic health conditions and other health concerns that may result in suboptimal scholastic achievement and other quality of life measures. Conveniently located in or near school buildings and providing affordable, child- and adolescent-focused care, SBHCs reduce barriers to youth accessing high quality health care. SBHCs provide essential preventive care services such as comprehensive physical examinations and immunizations to students without a primary care provider, assist in the management of chronic health conditions such as asthma, and provide reproductive and sexual health services such as the provision of contraceptives, screening and treatment for sexually transmitted infections (STIs), and management of pregnancy. Additionally, some SBHCs provide vision screenings, dental care, and nutrition counseling to students who may not otherwise access these services. SBHCs have been demonstrated to be a cost-effective model of health care delivery, reducing both health care and societal costs related to illness, disability, and lost productivity.
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Affiliation(s)
- Khalida Itriyeva
- Cohen Children's Medical Center, Division of Adolescent Medicine, Northwell, New Hyde Park, NY.
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Haeder SF, Marthey D, Skinner D. US public opinion about reproductive health care in school-based health centers. Contraception 2024; 132:110374. [PMID: 38244833 DOI: 10.1016/j.contraception.2024.110374] [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: 08/31/2023] [Revised: 01/13/2024] [Accepted: 01/16/2024] [Indexed: 01/22/2024]
Abstract
OBJECTIVES This study aimed to examine public support for the provision of seven reproductive health services in school-based health centers, including pregnancy testing, over-the-counter contraceptives, prescription (Rx) contraceptives, sexually transmitted disease testing, sexually transmitted disease treatment, gynecological examinations, sexual violence counseling, and an index measure combining all services. STUDY DESIGN We administered a large national online survey (N = 4196, response rate 31%) of US adults using Lucid, a large, internet-based, opt-in panel to assess public attitudes about offering sexual and reproductive health services in school-based health centers. We then used t tests and weighted linear regression models to carry out our study objectives. RESULTS Unadjusted analysis revealed that 60% of respondents supported the provision of all reproductive health services (combined) at school-based health centers. Regression analysis based on the index measure suggested that individuals identifying as Trump voters (p-value = 0.00) or conservatives (p-value = 0.00) reported the lowest support, while those identifying as liberal (p-value = 0.00) reported the highest support, controlling for demographic and health characteristics. CONCLUSIONS Respondents overwhelmingly support the provision of reproductive health services at school-based health centers, including pregnancy testing, over-the-counter contraceptives, prescription contraceptives, testing and treatment for sexually transmitted infections, and sexual violence counseling. IMPLICATIONS Adolescence is an important stage for sexual maturation, and access to appropriate sexual and reproductive health services can support healthy development into adulthood. Findings suggest that most respondents support the provision of reproductive health services at school-based health centers while there are important factors that influence public support.
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Affiliation(s)
- Simon F Haeder
- Department of Health Policy & Management, School of Public Health, Texas A&M University, College Station, TX, United States.
| | - Daniel Marthey
- Department of Health Policy & Management, School of Public Health, Texas A&M University, College Station, TX, United States
| | - Daniel Skinner
- Department of Social Medicine, Ohio University, Heritage College of Osteopathic Medicine, Dublin, OH, United States
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Waghmare BV, Jajoo S. Navigating the Challenges: A Comprehensive Review of Adolescent Gynecological Problems. Cureus 2024; 16:e56200. [PMID: 38618317 PMCID: PMC11016329 DOI: 10.7759/cureus.56200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 03/14/2024] [Indexed: 04/16/2024] Open
Abstract
This comprehensive review delves into the spectrum of adolescent gynecological problems, shedding light on the multifaceted challenges faced by individuals between the ages of 10 and 19. Covering normal developmental changes, common issues such as menstrual disorders, and the intricate interplay of psychosocial and cultural factors, the review provides a holistic understanding of adolescent gynecological health. Key findings underscore the importance of tailored education, destigmatizing reproductive health discussions, and recognizing the critical role of mental health in overall well-being. The conclusion issues a compelling call to action, urging healthcare providers to adopt patient-centered practices, educators to integrate comprehensive sexual education, and policymakers to advocate for inclusive policies. This review serves as a valuable resource, guiding collective efforts to enhance the well-being of adolescents as they navigate the challenges of gynecological health on their journey to adulthood.
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Affiliation(s)
- Bhavana V Waghmare
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Shubhada Jajoo
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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Maier MC, Gold MA, Vacca SH, Garbers S. Mixed-methods Exploration of Telehealth-supported Long-acting Reversible Contraceptive Services in School-based Health Centers: How Much Added Value? J Pediatr Health Care 2023; 37:599-608. [PMID: 37256251 DOI: 10.1016/j.pedhc.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/10/2023] [Indexed: 06/01/2023]
Abstract
INTRODUCTION This study explored adolescent and young adult preferences and experiences with telehealth-supported long-acting reversible contraceptive (LARC) services in New York City school-based health centers (SBHCs) during COVID-19. METHOD Sequential mixed methods included post-LARC insertion surveys and in-depth interviews. RESULTS Survey respondents (n = 45) were aged 14-21 years and predominantly Hispanic (53.3%). Only four respondents completed a postinsertion visit via telehealth. Most (82.2%) preferred in-person for future LARC visits; none preferred telehealth. Four themes emerged in interviews (n = 15): LARC self-efficacy and autonomy; SBHC convenience and accessibility; comfort with SBHC providers; and preference for in-person visits despite telehealth benefits. DISCUSSION Although telehealth theoretically adds value to LARC service delivery, uptake and preference for telehealth in the SBHC context were low. Despite the perceived acceptability of telehealth, adolescents and young adults prefer in-person SBHC visits, suggesting SBHC access may eliminate barriers to care that telehealth seeks to overcome.
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Ahmed N, Pike C, Lee J, Wagner C, Bekker LG. School-based healthcare services in Cape Town, South Africa: When there's a will, there's a way. Afr J Prim Health Care Fam Med 2023; 15:e1-e3. [PMID: 37916715 PMCID: PMC10623473 DOI: 10.4102/phcfm.v15i1.4216] [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: 06/28/2023] [Revised: 08/30/2023] [Accepted: 09/07/2023] [Indexed: 11/03/2023] Open
Abstract
South African secondary schools do not deliver school-based healthcare services despite high rates of human immunodeficiency virus (HIV) infection, sexually transmitted infections, and unplanned pregnancies among adolescents, ongoing sub-optimal uptake of healthcare services from public healthcare facilities by adolescents, and national policy support for such services. A pilot school health nursing programme (SHNP) was offered to 44 secondary schools in a single health sub-district within the Western Cape, South Africa. The programme included fortnightly nurse visits that offered a standard package of healthcare services, including sexual and reproductive health services tailored according to school preference.Of the 44 schools, 42 gave permission for the SHNP to operate, with the majority of schools selecting the full comprehensive package of services. Programme implementation was truncated such that delivery only occurred over two school terms (20 weeks); however, 344 students attended the service. The majority of service users were female with a median age of 16 years, and over a half attended the service for sexual and reproductive health services.Contribution: A key challenge to school-based health service delivery arose from inadequate stakeholder support and differential views of adolescent healthcare needs among government officials, parents, guardians, school staff and governing bodies. These findings motivate for ongoing multi-level stakeholder engagement around the reality of adolescent healthcare needs and further opportunities to deliver school health services for longer time periods such that their feasibility, acceptability, and potential to impact healthcare outcomes can be assessed in this setting.
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Affiliation(s)
- Nadia Ahmed
- Mortimer Market Centre, Central North West London NHS Trust, London, United Kingdom; and, Desmond Tutu HIV Centre, Faculty of Health Sciences, University of Cape Town, Cape Town.
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Boudreaux M, Chu J, Lipton BJ. School-Based Health Centers, Access to Care, and Income-Based Disparities. JAMA Netw Open 2023; 6:e2334532. [PMID: 37721750 PMCID: PMC10507491 DOI: 10.1001/jamanetworkopen.2023.34532] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/13/2023] [Indexed: 09/19/2023] Open
Abstract
Importance School-based health centers (SBHCs) are primary care clinics colocated at schools. SBHCs have the potential to improve health care access and reduce disparities, but there is limited rigorous evidence on their effectiveness at the national level. Objective To determine whether county-level adoption of SBHCs was associated with access, utilization, and health among children from low-income families and to measure reductions in income-based disparities. Design, Setting, and Participants This survey study used a difference-in-differences design and data from a nationally representative sample of children in the US merged with SBHC indicators from the National Census of School-Based Health Centers. The main sample included children aged 5 to 17 years with family incomes that were less than 200% of the federal poverty level observed in the National Health Interview Survey, collected between 1997 to 2018. The sample was restricted to children living in a county that adopted a center between 2003 and 2013 or that did not have a center at any time during the study period. Analyses of income-based disparities included children from higher income families (ie, 200% or higher than the federal poverty level). Data were analyzed between January 2020 and July 2023. Exposure County-by-year SBHC adoption. Main Outcomes and Measures Outcomes included access (usual source of care, insurance status, barriers), ambulatory care use (general physician, eye doctor, dental, mental health visits), and health (general health status, missed school days due to illness). P values were adjusted for multiple comparisons using the sharpened q value method. Results This study included 12 624 unweighted children from low-income families and 24 631 unweighted children from higher income families. The weighted percentage of children in low-income families who resided in counties with SBHC adoption included 50.0% aged 5 to 10 years. The weighted percentages of the race and ethnicity of these children included 36.7% Hispanic children, 25.2% non-Hispanic Black children, and 30.6% non-Hispanic White children. The weighted percentages of children in the counties that never adopted SBHCs included 50.1% aged 5 to 10 years. The weighted percentages of the race and ethnicity of these children included 20.7% Hispanic children, 22.4% non-Hispanic Black children, and 52.9% non-Hispanic White children. SBHC adoption was associated with a 6.4 percentage point increase in dental visits (95% CI, 3.2-9.6 percentage points; P < .001), an 8.0 percentage point increase in having a usual source of care (95% CI, 4.5-11.5 percentage points; P < .001), and a 5.2 percentage point increase in insurance (95% CI, 1.2-9.2 percentage points; P = .03). No other statistically significant associations were found with other outcomes. SBHCs were associated with relative reductions in income-based disparities to dental visits by 76% (4.9 percentage points; 95% CI, 2.0-7.7 percentage points), to insured status by 63% (3.5 percentage points; 95% CI, 1.3-5.7 percentage points), and to having a usual source of care by 98% (7.2 percentage points; 95% CI, 5.4-9.1 percentage points). Conclusions and Relevance In this survey study with difference-in-differences analysis of SBHC adoption, SBHCs were associated with access to care and reduced income-based disparities. These findings support additional SBHC expansion.
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Affiliation(s)
- Michel Boudreaux
- Department of Health Policy and Management, University of Maryland, College Park
| | - Jun Chu
- Department of Sociology, Anthropology, and Public Health, University of Maryland, Baltimore County, Baltimore
| | - Brandy J. Lipton
- Department of Health, Society, and Behavior, University of California, Irvine
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Lisk S, Sagar-Ouriaghli I, Carter B, Sclare I, Holly J, Brown JSL. Engaging Older Adolescent Boys Into School-Based Mental Health Workshops: Testing Theory-Based Facilitators and Barriers in Focus Groups. Am J Mens Health 2023; 17:15579883231177975. [PMID: 37822122 PMCID: PMC10571706 DOI: 10.1177/15579883231177975] [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: 01/24/2023] [Revised: 04/17/2023] [Accepted: 05/08/2023] [Indexed: 10/13/2023] Open
Abstract
Untreated mental health problems continue from childhood and adolescence into adulthood, meaning accessible early intervention is essential to reduce long-term negative outcomes. However, there is often a reluctance to engage in mental health treatment, with considerable evidence that young men are less likely to seek help than young women. This original research study aimed to explore four areas of interest around facilitating engagement of adolescent boys to a stress workshop intervention for adolescents in U.K. schools. The areas explored were male role models, destigmatizing language, trust building, and using a transparent and collaborative approach. We also sought to understand the main barriers to engagement. To explore these areas of interest, two focus groups were run, with a total of 12 young men, over two regional sites (London and Bath). Content analysis was used to analyze the data. Participants particularly valued transparency and collaboration as strong facilitators to engagement. Building of trust was the next most popular. Use of role models and destigmatizing language were the joint third most popular methods. The main barrier to help-seeking identified was perceived threat to masculine identity (self and social stigma). Given these novel findings, the factors of transparency and collaboration and building trust as facilitators merit further research, among both adults and adolescents.
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Affiliation(s)
- Stephen Lisk
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Ilyas Sagar-Ouriaghli
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Ben Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
| | - Irene Sclare
- Southwark CAMHS Clinical Academic Group, South London & Maudsley NHS Foundation Trust, London, UK
| | - Jennifer Holly
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - June S. L. Brown
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
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Munshi I, Ishaq JK, Liebhardt B, Goncy EA. Maternal Communication About Sexual Content and Ease of Access to Contraceptives. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:1607-1616. [PMID: 36385683 DOI: 10.1007/s10508-022-02476-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 06/16/2023]
Abstract
Previous literature has emphasized the role of mothers in sexual health communication with their adolescents. However, the extant literature lacks exploration of the importance of parental communication in association to specific risk-reduction behaviors, such as access to contraceptives. Therefore, the purpose of the current study was to explore the roles of parental attachment, the mother-daughter relationship, and communication about sexual content during adolescence in relation to women's recalled access to contraceptives during their teen years. Cisgender female participants aged between 18 and 35 (N = 582) were retrospectively assessed on maternal and paternal attachment, the mother-daughter relationship, mother-daughter communication about sexual content, and their own access to contraceptives during their teen years. After controlling for socioeconomic status, participant race, and history of pregnancy, only maternal communication about sexual content significantly related to access to contraceptives and ease of access to contraceptives. These results demonstrated that specific communication about sexual content was associated with greater access and ease of access to contraceptives, whereas more general relationship factors and communication did not.
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Affiliation(s)
- Ishita Munshi
- Department of Psychology, Cleveland State University, 2121 Euclid Avenue, Cleveland, OH, 44115, USA
| | - Jennifer K Ishaq
- Department of Psychology, Cleveland State University, 2121 Euclid Avenue, Cleveland, OH, 44115, USA
| | - Briana Liebhardt
- Department of Psychology, Cleveland State University, 2121 Euclid Avenue, Cleveland, OH, 44115, USA
| | - Elizabeth A Goncy
- Department of Psychology, Cleveland State University, 2121 Euclid Avenue, Cleveland, OH, 44115, USA.
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D'Souza P, Phagdol T, D'Souza SRB, D S A, Nayak BS, Velayudhan B, Bailey JV, Stephenson J, Oliver S. Interventions to support contraceptive choice and use: a global systematic map of systematic reviews. EUR J CONTRACEP REPR 2023; 28:83-91. [PMID: 36802955 DOI: 10.1080/13625187.2022.2162337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
BACKGROUND To review the highest level of available evidence, a systematic map identified systematic reviews that evaluated the effectiveness of interventions to improve contraception choice and increase contraception use. METHODS Systematic reviews published since 2000 were identified from searches of nine databases. Data were extracted using a coding tool developed for this systematic map. Methodological quality of included reviews was assessed using AMSTAR 2 criteria. FINDINGS AND CONCLUSION Fifty systematic reviews reported evaluations of interventions for contraception choice and use addressing three domains (individual, couples, community); Meta-analyses in 11 of the reviews mostly addressed interventions for individuals. We identified 26 reviews covering High Income Countries, 12 reviews covering Low Middle-Income Countries and the rest a mix of both. Most reviews (15) focussed on psychosocial interventions, followed by incentives (6) and m-health interventions (6). The strongest evidence from meta-analyses is for the effectiveness of motivational interviewing, contraceptive counselling, psychosocial interventions, school-based education, and interventions promoting contraceptive access, demand-generation interventions (community and facility based, financial mechanisms and mass media), and mobile phone message interventions. Even in resource constrained settings, community-based interventions can increase contraceptive use. There are gaps in the evidence on interventions for contraception choice and use, and limitations in study designs and lack of representativeness. Most approaches focus on individual women rather than couples or wider socio-cultural influences on contraception and fertility. This review identifies interventions which work to increase contraception choice and use, and these could be implemented in school, healthcare or community settings.
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Affiliation(s)
- Preethy D'Souza
- UCL Social Research Institute, University College London, London, UK
| | - Tenzin Phagdol
- Department of Pediatric Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Sonia R B D'Souza
- Department of Obstetrics and Gynaecological Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Anupama D S
- Department of Obstetrics and Gynaecological Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Baby S Nayak
- Department of Pediatric Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Binil Velayudhan
- Department of Mental Health Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Julia V Bailey
- Research Department of Primary Care and Population Health, University College London, Royal Free Hospital, London, UK
| | | | - Sandy Oliver
- UCL Social Research Institute, University College London, London, UK.,Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
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Mkpanam N, Mpama E, Ekpenyong N, Omoronyia O, Agbor I. Comparative study of sexual health knowledge and practices among sexually active adolescent girls in co-educational and girls-only secondary school in Calabar, Nigeria. Pan Afr Med J 2022; 43:157. [PMID: 36785677 PMCID: PMC9922073 DOI: 10.11604/pamj.2022.43.157.35942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 10/04/2022] [Indexed: 11/27/2022] Open
Abstract
Introduction there is little or no progress towards the attainment of sexual and reproductive health (SRH) targets of the Sustainable Development Goals (SDGs) in many developing country settings. Key SRH gap in these settings includes suboptimal knowledge-based safe sexual practices, especially among adolescent girls as a vulnerable subpopulation. Unique features of school environmental settings including gender segregation have not been harnessed for cost-effective sexual health education, perhaps due to the current paucity of literature. This study was aimed at comparing sexual health knowledge and practices, between sexually active adolescent girls in co-educational and girl-only secondary schools in Calabar, Nigeria. Methods cross-sectional comparative study design was used. Sexually active adolescent girls were randomly recruited from co-educational and girl-only secondary schools in Calabar, Nigeria. Validated questionnaire developed by the United Nations Educational Scientific and Cultural Organization (UNESCO), was used to assess sexual health knowledge and behavioral practice. Factors associated with a satisfactory level of knowledge were assessed using the Chi-square test. Data analysis was done using SPSS version 24.0, with the p-value set at 0.05. Ethical approval was obtained before data collection. Results one hundred and twenty respondents were studied, comprising an equal proportion of sixty (60) in co-educational and girl-only schools. Mean age and age at sexual debut were 16.4 ± 1.8 and 14.3 ± 2.2 years, respectively. Compared with group 1 (co-education), respondents in group 2 (girl-only) had significantly higher mean knowledge scores (26.1 vs. 30.4, p<0.05). Fifty respondents (41.7%) had a satisfactory level of knowledge of sexual health. There was no significant difference in mean practice scores comparing groups 1 and 2 (20.4 vs. 21.5, p>0.05). Internet use, unmarried parental status, and not living with both parents, were associated with unsatisfactory levels of knowledge on sexual health. Conclusion compared with co-educational schools, girl-only schools have better sexual health knowledge, but a similar level of behavioral practices. There is a need for improvement in sexual health education efforts among adolescent girls, perhaps with more focus on coed schools, within the context of potential inherent disadvantage in the school environmental setting.
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Affiliation(s)
- Nkese Mkpanam
- Department of Community Medicine, University of Calabar, Calabar, Nigeria
| | - Enagu Mpama
- Department of Community Medicine, University of Calabar, Calabar, Nigeria
| | - Nnette Ekpenyong
- Department of Community Medicine, University of Calabar, Calabar, Nigeria
| | - Ogban Omoronyia
- Department of Community Medicine, University of Calabar, Calabar, Nigeria,Corresponding author: Ogban Omoronyia, Department of Community Medicine, University of Calabar, Calabar, Nigeria.
| | - Iwasam Agbor
- Department of Community Medicine, University of Calabar, Calabar, Nigeria
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Seilo N, Paldanius S, Autio R, Koskela T, Kunttu K, Kaila M. Association between university students' two-staged health screening and student health care utilisation: register based observational study. BMJ Open 2022; 12:e052824. [PMID: 35820768 PMCID: PMC9277381 DOI: 10.1136/bmjopen-2021-052824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES The aim of this study was to explore how university students' participation in a two-staged health screening at the beginning of university studies associates with student health care utilisation in a 6-year follow-up. DESIGN Nationwide, observational, register-based cohort study with a 6-year follow-up. SETTING Student health care in Finland. Finnish Student Health Service (FSHS) provides statutory student health services to university students in Finland. The two-staged health screening of FSHS includes the electronic health questionnaire (eHQ) provided annually to university entrants and a subsequent health check, when necessary, based on students eHQ response. PARTICIPANTS A national cohort of university entrants from the 2011-2012 academic year (N=15 723) was assessed. After exclusions the study population consisted of 12 972 students, n (female)=7368, n (male)=5604. OUTCOME MEASURES The primary outcome measures were students' health service utilisation pattern obtained by clustering analyses method and the students' participation in different stages of the health examination process. RESULTS Four distinguishable health care utilisation patterns were identified: (1) constant low use, (2) constant high use, (3) increasing use and (4) decreasing use. The students' OR for belonging to the constant high use group was significantly higher among females (OR 4.0, 95% CI 3.5 to 4.6) and students who attended the health check (OR 4.7, 95% CI 3.9 to 5.6). CONCLUSIONS Participating in the two-staged health screening was associated with increase in health care utilisation. The process detects students with health problems.
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Affiliation(s)
- Noora Seilo
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Susanna Paldanius
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Reija Autio
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Tuomas Koskela
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Center of General Practice, Tampere University Hospital, Tampere, Finland
| | | | - Minna Kaila
- Public Health Medicine, University of Helsinki, Helsinki, Finland
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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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14
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Gruber JA, Anderson-Carpenter KD, McNall M, Clark SL. Understanding the Longitudinal Impact of School-Based Health Centers on Student Attendance. CHILD & YOUTH CARE FORUM 2022. [DOI: 10.1007/s10566-022-09691-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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15
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Obach A, Sadler M, Cabieses B, Bussenius P, Muñoz P, Pérez C, Urrutia C. Strengths and challenges of a school-based sexual and reproductive health program for adolescents in Chile. PLoS One 2022; 17:e0265309. [PMID: 35320306 PMCID: PMC8942266 DOI: 10.1371/journal.pone.0265309] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 02/28/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Adolescent sexual and reproductive health services in Chile have been primarily provided through health centers. Although some school-based initiatives have been implemented, to date, these have not been assessed. This study aims to identify strengths and challenges of the affectivity and sexuality component of the school-based 3A Program, a health program which seeks to prevent risk behaviors and promote healthy lifestyle habits within public schools (addressing health topics which in Spanish begin with the letter ‘A’, hence ‘3A’), implemented in the municipality of Lo Prado, city of Santiago.
Methods
We carried out a qualitative study with a descriptive-interpretative approach in three schools. We conducted in-depth interviews with students, teachers, health professionals, and school principals (N = 44); and focus groups with students (N = 3), teachers and health personnel (N = 3). The interviews were analyzed using thematic analysis.
Results
Participants highlight the integrative approach to health and to sexual and reproductive health promoted in the 3A Program, which is enhanced by the collaboration of interdisciplinary health teams. Permanent and expedited student access to sexual and reproductive health care is achieved, and affectional bonds are developed between students and the Program’s health staff. The Program assists female participants to imagine and form identities that are not inherently tied to motherhood. It also assists boys and LGBTQ+ adolescents in feeling included as relevant actors in sexual and reproductive health and decision making. The delivery of contraception in schools is highly valued. The most significant challenge identified is ensuring effective and ongoing collaboration between health staff and teachers.
Conclusion
Participants value the effectivity and sexuality component of the 3A Program as an initiative to improve adolescents’ access to sexual and reproductive health care. Our findings suggest that this Program could be replicated throughout the region and the country to improve the quality and accessibility of health services for adolescents.
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Affiliation(s)
- Alexandra Obach
- Programa de Estudios Sociales en Salud, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
- * E-mail:
| | - Michelle Sadler
- Departamento de Historia y Ciencias Sociales, Facultad de Artes Liberales, Universidad Adolfo Ibáñez, Santiago, Chile
| | - Báltica Cabieses
- Programa de Estudios Sociales en Salud, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Pascale Bussenius
- Programa de Estudios Sociales en Salud, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Patricia Muñoz
- Corporación Municipal de Lo Prado, Ilustre Municipalidad de Lo Prado, Santiago, Chile
| | - Claudia Pérez
- Programa de Estudios Sociales en Salud, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Carla Urrutia
- Programa de Estudios Sociales en Salud, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
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16
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Sullivan EE, Love HL, Fisher RL, Schlitt JJ, Cook EL, Soleimanpour S. Access to Contraceptives in School-Based Health Centers: Progress and Opportunities. Am J Prev Med 2022; 62:350-359. [PMID: 34922786 DOI: 10.1016/j.amepre.2021.08.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 08/16/2021] [Accepted: 08/19/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The U.S. has a higher adolescent pregnancy rate than other industrialized countries. School-based health centers can improve access to contraceptives among youth, which can prevent unplanned pregnancies. This cross-sectional study examines the characteristics and predictors of contraceptive provision at school-based health centers in 2016-2017 and changes in and barriers to provision between 2001 and 2017. METHODS In 2020-2021, the authors conducted analyses of the National School-Based Health Care Census data collected from 2001 to 2017. The primary outcome of interest was whether adolescent-serving school-based health centers dispense contraceptives, and a secondary outcome of interest was the policies that prohibit school-based health centers from dispensing contraceptives. A multivariate regression analysis examined the associations between contraceptive provision and various covariates, including geographic region, years of operation, and provider team composition. RESULTS Less than half of adolescent-serving school-based health centers reported providing contraceptives on site. Those that provided contraceptives were more likely located in the Western and Northeastern regions of the U.S., older in terms of years of operation, and staffed by a wide variety of health provider types. Among school-based health centers that experienced policy barriers to providing access to contraceptive methods, most attributed the source to the school or school district where the school-based health center was located. CONCLUSIONS School-based health centers are an evidence-based model for providing contraceptives to adolescents but not enough are providing direct access. Understanding the predictors, characteristics, and barriers influencing the provision of contraceptives at school-based health centers may help to expand the number doing so.
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Affiliation(s)
- Erin E Sullivan
- Research and Evaluation, School-Based Health Alliance, Washington, District of Columbia.
| | - Hayley L Love
- Research and Evaluation, School-Based Health Alliance, Washington, District of Columbia
| | - Rebecca L Fisher
- New York City Department of Health and Mental Hygiene, Office of School Health & Bureau of Maternal, Infant, and Reproductive Health, New York, New York
| | - John J Schlitt
- Research and Evaluation, School-Based Health Alliance, Washington, District of Columbia
| | - Elizabeth L Cook
- Reproductive Health and Family Formation, Child Trends, Bethesda, Maryland
| | - Samira Soleimanpour
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California
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17
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Gersh E, Richardson LP, Coker TR, Inwards-Breland DJ, McCarty CA. Same, opposite and both-sex attracted adolescents' mental health, safe-sex practices and substance use. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2022; 26:196-211. [PMID: 36249124 PMCID: PMC9555790 DOI: 10.1080/19359705.2021.1967826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
This study examined mental health, substance use, and sexual health across sexual attraction groups. 428 adolescents recruited from school-based health centers completed self-report measures. 72% were only opposite-sex attracted, 19% both-sex attracted, 3% same-sex attracted, 4% not sure. Reported partners did not always align with reported attraction. Compared to opposite-sex attracted youth, 1) both-sex attracted youth had significantly higher rates of marijuana use (OR=1.75, p=.04), depressive symptoms (OR=2.62, p=.001) and inconsistent condom use (OR=1.71, p=.05); 2) the "not sure" group had higher anxiety symptoms (OR=4, p=.01). This study highlights the importance of considering sexual attraction in providing quality care to young people.
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Affiliation(s)
- Elon Gersh
- Centre for Youth Mental health, University of Melbourne, Australia
| | - Laura P Richardson
- Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, Washington.,Department of Pediatrics, University of Washington, Seattle, Washington
| | - Tumaini R Coker
- Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, Washington.,Department of Pediatrics, University of Washington, Seattle, Washington
| | | | - Carolyn A McCarty
- Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, Washington.,Department of Pediatrics, University of Washington, Seattle, Washington
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18
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Supporting adolescents living with HIV within boarding schools in Kenya. PLoS One 2021; 16:e0260278. [PMID: 34855779 PMCID: PMC8638902 DOI: 10.1371/journal.pone.0260278] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 11/06/2021] [Indexed: 11/19/2022] Open
Abstract
Adolescents and youth living with HIV (AYLHIV) are a uniquely vulnerable population facing challenges around adherence, disclosure of HIV status and stigma. Providing school-based support for AYLHIV offers an opportunity to optimize their health and wellbeing. The purpose of this study was to evaluate the feasibility of school-based supportive interventions for AYLHIV in Kenya. From 2016–2019, with funding from ViiV Healthcare, the Elizabeth Glaser Pediatric AIDS Foundation implemented the innovative Red Carpet Program (RCP) for AYLHIV in participating public healthcare facilities and boarding schools in Homa Bay and Turkana Counties in Kenya. In this analysis, we report the implementation of the school-based interventions for AYLHIV in schools, which included: a) capacity building for overall in-school HIV, stigma and sexual and reproductive health education; b) HIV care and treatment support; c) bi-directional linkages with healthcare facilities; and d) psychosocial support (PSS). Overall, 561 school staff and 476 school adolescent health advocates received training to facilitate supportive environments for AYLHIV and school-wide education on HIV, stigma, and sexual and reproductive health. All 87 boarding schools inter-linked to 66 regional healthcare facilities to support care and treatment of AYLHIV. Across all RCP schools, 546 AYLHIV had their HIV status disclosed to school staff and received supportive care within schools, including treatment literacy and adherence counselling, confidential storage and access to HIV medications. School-based interventions to optimize care and treatment support for AYLHIV are feasible and contribute to advancing sexual and reproductive health within schools.
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19
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Jolliff A, Zhao Q, Eickhoff J, Moreno M. Depression, Anxiety, and Daily Activity Among Adolescents Before and During the COVID-19 Pandemic: Cross-sectional Survey Study. JMIR Form Res 2021; 5:e30702. [PMID: 34609316 PMCID: PMC8641699 DOI: 10.2196/30702] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/30/2021] [Accepted: 09/27/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has resulted in significant changes to adolescents' daily lives and, potentially, to their mental health. The pandemic has also disproportionately affected historically marginalized and at-risk communities, including people of color, socioeconomically disadvantaged people, people identifying as female, and youth. OBJECTIVE This study aimed to understand differences in depression and anxiety among 2 groups of adolescents in the United States before and during the COVID-19 pandemic, and to examine demographic and daily activity variables associated with depression and anxiety. METHODS Online surveys were distributed in 2019 and 2020. Demographic questions were asked at the time of enrollment, and included participants' age, gender, race and ethnicity, and socioeconomic status (SES). The 8-item Patient Health Questionnaire was used to assess symptoms of depression, and the 7-item Generalized Anxiety Disorder scale was used to assess symptoms of anxiety. A total of 4 pandemic-specific daily activity questions were asked only of the pandemic group. Analyses of covariance compared depression and anxiety between prepandemic and pandemic groups. Demographic and lifestyle variables were included as covariates. RESULTS The sample comprised a total of 234 adolescents, with 100 participants in the prepandemic group and 134 participants in the pandemic group. Within the pandemic group, 94% (n=126) of adolescents reported being out of school due to the pandemic, and another 85.8% (n=115) and 57.1% (n=76) were prevented from extracurricular activities and exercise, respectively. Higher depression was seen in the pandemic group, with a least-squares adjusted mean of 7.62 (SD 1.36) compared to 6.28 (SD 1.42) in the prepandemic group, although the difference was not significant (P=.08). There was no significant difference in anxiety scores between the 2 groups (least-squares adjusted means 5.52, SD 1.30 vs 5.01, SD 1.36; P=.48). Within the pandemic group, lower SES was predictive of anxiety, such that those in the pandemic group of lower SES were more anxious than their higher-SES peers (least-squares adjusted means 11.17, SD 2.34 vs 8.66, SD 2.16; P=.02). Within the pandemic group, being out of work or school and not partaking in extracurricular activities or exercise due to the pandemic were not associated with higher depression or anxiety scores. CONCLUSIONS In this study, neither being in the pandemic group nor experiencing changes in daily activity due to the pandemic was associated with higher depression or anxiety. However, we found that adolescents from lower SES backgrounds experienced significantly more anxiety during the pandemic than their more privileged peers. Both instrumental and mental health interventions for low-income adolescents are imperative.
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Affiliation(s)
- Anna Jolliff
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI, United States
| | - Qianqian Zhao
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI, United States
| | - Jens Eickhoff
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI, United States
| | - Megan Moreno
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI, United States
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20
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Chingono RMS, Mackworth-Young CRS, Ross DA, Tshuma M, Chiweshe T, Nyamayaro C, Sekanevana C, Doyle AM, Weiss HA, Kohl K, Mangombe A, Madzima B, McHugh G, Ferrand RA. Designing Routine Health Checkups for Adolescents in Zimbabwe. J Adolesc Health 2021; 69:940-947. [PMID: 34362647 PMCID: PMC7614877 DOI: 10.1016/j.jadohealth.2021.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 06/14/2021] [Accepted: 07/01/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The absence of routine health check-ups during adolescence in low- and middle-income countries is a missed opportunity for prevention, early identification, and treatment of health issues, and health promotion. We aimed to codesign the content and delivery for routine adolescent health checkups in Zimbabwe, with adolescents and key adults in their lives. METHODS We held participatory workshops with adolescents (16 workshops; 96 adolescents) and parents (8 workshops; 95 parents), and in-depth interviews with key informants including policymakers, programmers, and healthcare workers (n = 25). Analysis was iterative and the design of the checkups was refined based on participant preferences, document review of burden of disease data, and feasibility considerations. RESULTS Participants overwhelmingly supported the introduction of routine health checkups. Reported facilitators to attendance included free cost and desire to know one's health status. Barriers included tendencies for health service seeking only when ill, fear of diagnosis and judgment, and religious beliefs. Delivery preferences were by nonjudgmental medical professionals, in a youth friendly environment, and accompanied by youth engagement activities. Preferred location was schools for younger adolescents (10-14 years), and community settings for older adolescents (15-19 years). Prioritized content included sexual health, oral health, mental health, hearing, eyesight, growth and nutrition, anemia, immunization, and deworming, based on health burden and participant preferences. DISCUSSION This study resulted in an outline design of two routine health checkups with stakeholders in Zimbabwe, in schools for young adolescents, and in community settings for older adolescents. Evidence of feasibility, effectiveness, and cost-effectiveness of such checkups is required.
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Affiliation(s)
- Rudo M S Chingono
- Biomedical Research and Training Institute, Harare, Zimbabwe; Institute of Global Health, University College of London, London, United Kingdom
| | - Constance R S Mackworth-Young
- Biomedical Research and Training Institute, Harare, Zimbabwe; Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - David A Ross
- Maternal, Newborn, Child & Adolescent Health and Ageing Department, World Health Organization, Geneva, Switzerland
| | - Maureen Tshuma
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Tendai Chiweshe
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Chipo Nyamayaro
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | | | - Aoife M Doyle
- MRC International Statistics and Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Helen A Weiss
- MRC International Statistics and Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kid Kohl
- Maternal, Newborn, Child & Adolescent Health and Ageing Department, World Health Organization, Geneva, Switzerland
| | - Aveneni Mangombe
- Family Health Department, Ministry of Health and Child Care, Harare, Zimbabwe
| | | | - Grace McHugh
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Rashida A Ferrand
- Biomedical Research and Training Institute, Harare, Zimbabwe; Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
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21
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Abstract
School-based health centers (SBHCs) are unique health care settings for our nation's school-aged children and adolescents. SBHCs represent the collaboration between the health and school communities to support the health and mental health needs and the academic achievements of children and adolescents, particularly students with health disparities or poor access to health care. SBHCs improve access to health care services for students by decreasing financial, geographic, age, and cultural barriers. This policy statement provides an overview of SBHCs, including the scope of services as well as some of the documented benefits and challenges. This policy statement also reviews the role of SBHCs in working with the pediatric medical home and provides recommendations that support the coordination of SBHCs with pediatric primary care providers and the pediatric medical home.
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22
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Michaud PA, Vervoort JPM, Visser A, Baltag V, Reijneveld SA, Kocken PL, Jansen D. Organization and activities of school health services among EU countries. Eur J Public Health 2021; 31:502-508. [PMID: 33582798 DOI: 10.1093/eurpub/ckaa200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND School health services (SHS) can be defined as health services provided to enrol pupils by health professionals and/or allied professions. The aim of this study was to explore the current state of the governance, organization and workforce of SHS and their provision of preventive activities in European countries. METHODS Observational study. Data were collected as part of the Horizon 2020-funded project 'Models of Child Health Appraised'. Only 1 expert from each of the 30 included European countries answered a closed-items questionnaire during the years 2017 and 2018. RESULTS All countries (except Spain and the Czech Republic, which do not have formal SHS) provided school-based individual screening and health-enhancing measures. The majority performed height, weight, vision and hearing checks; some integrated other assessments of limited evidence-based effectiveness. Most countries also delivered health education and promotion activities in areas, such as sexual health, substance use and healthy nutrition. Almost all countries seemed to suffer from a shortage of school health professionals; moreover, many of these professionals had no specific training in the area of school health and prevention. CONCLUSIONS Many EU countries need better administrative and legal support. They should promote evidence-based screening procedures and should hire and train more school health professionals. Overall, they need to adapt to the evolving health priorities of pupils, adopt a more holistic paradigm and extend their activities beyond traditional screening or vaccination procedures.
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Affiliation(s)
| | - Johanna P M Vervoort
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Annemieke Visser
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Valentina Baltag
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organisation, Geneva, Switzerland
| | - Sijmen A Reijneveld
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,TNO Child Health, Leiden, The Netherlands
| | - Paul L Kocken
- Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Danielle Jansen
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Sociology and Interuniversity for Social Science Theory and Methodology (ICS), University of Groningen, Groningen, The Netherlands
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23
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Westbrook M, Martinez L, Mechergui S, Scandlyn J, Yeatman S. Contraceptive Access Through School-Based Health Centers: Perceptions of Rural and Suburban Young People. Health Promot Pract 2021; 23:425-431. [PMID: 34338038 DOI: 10.1177/15248399211026612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE School-based health centers (SBHCs) have traditionally been concentrated in urban centers but have increasingly moved to rural and suburban settings. Adolescents living outside urban centers continue to experience barriers accessing contraceptives and reproductive health care. SBHCs are well positioned to reduce these barriers since they often offer convenient, in-school reproductive health care services. We describe the experiences of adolescents and emerging adults as they navigate access to contraceptives at SBHCs and nonschool locations in nonurban, low-income communities. METHOD We interviewed 30 sexually active individuals aged 15 to 21 living in rural and suburban communities in Colorado where high school SBHCs were recently introduced. Participants reflected on their experiences with or without in-school access to sexual and reproductive health services. RESULTS Overall, young people supported within-school access to contraceptives, citing convenience, low cost, and greater confidentiality and privacy compared with out-of-school providers, particularly in rural areas. At the same time, findings point to the need for SBHCs to overcome adolescents' and emerging adults' misunderstanding of age requirements to access confidential contraceptive services and their remaining concerns around confidentiality in the school setting. CONCLUSIONS Our results indicate that SBHCs in low-income rural and suburban areas provide essential contraceptive services that young people access and value. Policy makers in nonurban communities should look to the SBHC model to reduce barriers for young people accessing reproductive health care, and health care providers should work to ensure confidentiality and to correct misinformation about their right to access contraceptive services.
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Colleran A, O'Connor A, Hogan MJ, Harney OM, Durand H, Hanlon M. Who asked you? Young People and practitioners identify ways to facilitate access to mental health supports. HRB Open Res 2021. [DOI: 10.12688/hrbopenres.13328.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Despite representing the highest level of total population mental health burden, young people are the least likely to seek help from mental health services. It has been suggested that service design can influence the likelihood that young people will look for help, but little is known about how young people would like a service to be designed. This study addresses a gap in research regarding how mental health services can be designed to facilitate access for young people. Methods: A collective intelligence, scenario-based design methodology was used to facilitate stakeholders to identify and prioritise ways to improve youth mental health services. In total, 74 15–17-year-olds from three geographically diverse schools in Ireland worked to identify barriers to help-seeking and to generate and prioritise options in response to barriers. Nine practitioners with experience of working in youth mental health services rated all options in terms of both potential impact on help-seeking and feasibility for service implementation. Results: A total of 326 barriers across 15 themes were generated by youth stakeholders, along with 133 options in response to barriers. Through a process of voting, young people identified 30 options as the most impactful for improving access to mental health services. Of these options, 12 were also rated by practitioners as having both high potential impact and high feasibility. These 12 options focused on four areas: making services more familiar and welcoming; providing specialist mental health input in schools; improving parental understanding; and improving the visibility of appropriate supports. Conclusions: The results of the current study inform mental health service innovation and development, in particular, by highlighting potentially impactful and feasible ways to adapt existing mental health services to improve young people’s help-seeking behaviour.
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George AS, Jacobs T, Kinney MV, Haakenstad A, Singh NS, Rasanathan K, Chopra M. Are rhetorical commitments to adolescents reflected in planning documents? An exploratory content analysis of adolescent sexual and reproductive health in Global Financing Facility country plans. Reprod Health 2021; 18:124. [PMID: 34134726 PMCID: PMC8210342 DOI: 10.1186/s12978-021-01121-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 03/11/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The Global Financing Facility (GFF) offers an opportunity to close the financing gap that holds back gains in women, children's and adolescent health. However, very little work exists examining GFF practice, particularly for adolescent health. As momentum builds for the GFF, we examine initial GFF planning documents to inform future national and multi-lateral efforts to advance adolescent sexual and reproductive health. METHODS We undertook a content analysis of the first 11 GFF Investment Cases and Project Appraisal Documents available on the GFF website. The countries involved include Bangladesh, Cameroon, Democratic Republic of Congo, Ethiopia, Guatemala, Kenya, Liberia, Mozambique, Nigeria, Tanzania and Uganda. RESULTS While several country documents signal understanding and investment in adolescents as a strategic area, this is not consistent across all countries, nor between Investment Cases and Project Appraisal Documents. In both types of documents commitments weaken as one moves from programming content to indicators to investment. Important contributions include how teenage pregnancy is a universal concern, how adolescent and youth friendly health services and school-based programs are supported in several country documents, how gender is noted as a key social determinant critical for mainstreaming across the health system, alongside the importance of multi-sectoral collaboration, and the acknowledgement of adolescent rights. Weaknesses include the lack of comprehensive analysis of adolescent health needs, inconsistent investments in adolescent friendly health services and school based programs, missed opportunities in not supporting multi-component and multi-level initiatives to change gender norms involving adolescent boys in addition to adolescent girls, and neglect of governance approaches to broker effective multi-sectoral collaboration, community engagement and adolescent involvement. CONCLUSION There are important examples of how the GFF supports adolescents and their sexual and reproductive health. However, more can be done. While building on service delivery approaches more consistently, it must also fund initiatives that address the main social and systems drivers of adolescent health. This requires capacity building for the technical aspects of adolescent health, but also engaging politically to ensure that the right actors are convened to prioritize adolescent health in country plans and to ensure accountability in the GFF process itself.
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Affiliation(s)
- Asha S George
- School of Public Health, University of the Western Cape, Bellville, Private Bag x17, Cape Town, 7535, South Africa.
| | - Tanya Jacobs
- School of Public Health, University of the Western Cape, Bellville, Private Bag x17, Cape Town, 7535, South Africa
| | - Mary V Kinney
- School of Public Health, University of the Western Cape, Bellville, Private Bag x17, Cape Town, 7535, South Africa
| | - Annie Haakenstad
- Department of Global Health and Population, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Neha S Singh
- Department of Global Health and Development, London School of Tropical Hygiene and Medicine, London, WC1E 7HT, UK
| | | | - Mickey Chopra
- World Bank, 1818 H Street, NW, Washington, DC, 20433, USA
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Boniface ER, Rodriguez MI, Heintzman J, Knipper S, Jacobs R, Darney BG. Contraceptive provision in Oregon school-based health centers: Method type trends and the role of Title X. Contraception 2021; 104:206-210. [PMID: 33781759 DOI: 10.1016/j.contraception.2021.03.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/17/2021] [Accepted: 03/21/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We describe provision of contraception to adolescents at Oregon school-based health centers (SBHCs). We examine trends over time, by race/ethnicity, and by Title X clinic status and test whether these factors are associated with provision of long-acting reversible contraception (LARC; intrauterine devices/IUDs and implants). STUDY DESIGN We conducted a retrospective cohort study of 33 SBHCs participating in a shared electronic health record 2012-2016. We identified 20,339 contraception provision visits to 5,934 adolescent females ages 14-19 using diagnosis and procedure codes. We used logistic regression to evaluate the association of clinic Title X status, race/ethnicity, and year with receipt of LARC, controlling for individual-, clinic-, and residence-level factors. We calculated adjusted probabilities. RESULTS Provision of IUDs and implants increased at Oregon SBHCs between 2012 and 2016. IUD provision increased almost 5-fold, (from 0.9% to 4.4% of contraception provision visits), and implants increased approximately 6.5-fold (from 1.1% to 7.2%). More adolescent contraception provision visits occurred at Title X SBHCs, which had greater than twice the adjusted probability of providing LARCs than non-Title X SBHCs (4.4% versus 1.7%). After adjusting for adolescent-, clinic-, and residence-level covariates, non-white adolescents had lower probabilities of receiving LARC methods than white adolescents. CONCLUSIONS SBHCs play an important role in providing access to contraceptive services to adolescents in Oregon. Access to IUDs and implants is increasing over time in SBHCs, particularly those that participate in the Title X program. IMPLICATIONS Adolescents have expanding access to IUDs and implants in SBHCs over time in Oregon. Participation in the Title X program can help further increase access to effective contraception in SBHCs.
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Affiliation(s)
- Emily R Boniface
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, United States.
| | - Maria I Rodriguez
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, United States
| | - John Heintzman
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Sarah Knipper
- Public Health Division, Oregon Health Authority, Portland, OR, United States
| | - Rebecca Jacobs
- Public Health Division, Oregon Health Authority, Portland, OR, United States
| | - Blair G Darney
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, United States; OHSU-Portland State University School of Public Health, Portland, OR, United States; Center for Population Health Research, National Institute of Public Health, Morelos, Mexico
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George A, Jacobs T, Ved R, Jacobs T, Rasanathan K, Zaidi SA. Adolescent health in the Sustainable Development Goal era: are we aligned for multisectoral action? BMJ Glob Health 2021; 6:e004448. [PMID: 33727279 PMCID: PMC7970238 DOI: 10.1136/bmjgh-2020-004448] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/10/2021] [Accepted: 02/15/2021] [Indexed: 11/24/2022] Open
Abstract
Adolescents are an increasing proportion of low and middle-income country populations. Their coming of age is foundational for health behaviour, as well as social and productive citizenship. We mapped intervention areas for adolescent sexual and reproductive health, including HIV, mental health and violence prevention to sectors responsible for them using a framework that highlights settings, roles and alignment. Out of 11 intervention areas, health is the lead actor for one, and a possible lead actor for two other interventions depending on the implementation context. All other interventions take place outside of the health sector, with the health sector playing a range of bilateral, trilateral supporting roles or in several cases a minimal role. Alignment across the sectors varies from indivisible, enabling or reinforcing to the other extreme of constraining and counterproductive. Governance approaches are critical for brokering these varied relationships and interactions in multisectoral action for adolescent health, to understand the context of such change and to spark, sustain and steer it.
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Affiliation(s)
- Asha George
- School of Public Health, University of the Western Cape Faculty of Community and Health Sciences, Cape Town, Western Province, South Africa
| | - Tanya Jacobs
- School of Public Health, University of the Western Cape Faculty of Community and Health Sciences, Cape Town, Western Province, South Africa
| | - Rajani Ved
- National Health Systems Resource Centre, New Delhi, Delhi, India
| | - Troy Jacobs
- Global Health Support Initiative III, Rockville, MD, USA
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | | | - Shehla Abbas Zaidi
- Community Health Sciences, Aga Khan University Faculty of Health Sciences, Karachi, Pakistan
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Opara I, Weissinger GM, Lardier DT, Lanier Y, Carter S, Brawner BM. Mental Health Burden among Black Adolescents: The Need for Better Assessment, Diagnosis and Treatment Engagement. SOCIAL WORK IN MENTAL HEALTH 2021; 19:88-104. [PMID: 34248423 PMCID: PMC8262091 DOI: 10.1080/15332985.2021.1879345] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
This study examines mental health symptoms among Black adolescents who were currently in mental health treatment and those who were not in treatment. The study uses a sample of Black adolescents (N=154) and logistic regression was performed to determine which psychological factors were associated with exhibiting mental health symptoms. Both groups experienced high amounts of trauma exposure history, recent suicidality, substance use, and depressive symptoms. Nearly one in four adolescents in the out of treatment group met diagnostic criteria for anxiety disorders. Implications include better screening for mental health symptoms to ensure Black adolescent have access to mental health treatment.
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Comfort AB, Rao L, Goodman S, Barney A, Glymph A, Schroeder R, McCulloch C, Harper CC. Improving Capacity at School-based Health Centers to Offer Adolescents Counseling and Access to Comprehensive Contraceptive Services. J Pediatr Adolesc Gynecol 2021; 34:26-32. [PMID: 32730800 PMCID: PMC7385555 DOI: 10.1016/j.jpag.2020.07.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 07/20/2020] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVES Many pediatric providers serving adolescents are not trained to offer comprehensive contraceptive services, including intrauterine devices (IUDs) and implants, despite high safety and satisfaction among adolescents. This study assessed an initiative to train providers at school-based health centers (SBHCs) to offer students the full range of contraceptive methods. DESIGN Surveys were administered at baseline pre-training and at follow-up 3 months post-training. Data were analyzed using generalized estimating equations for clustered data to examine clinical practice changes. SETTING Eleven contraceptive trainings at SBHCs across the United States from 2016-2019. PARTICIPANTS A total of 260 providers from 158 SBHCs serving 135,800 students. INTERVENTIONS On-site training to strengthen patient-centered counseling and to equip practitioners to integrate IUDs and implants into contraceptive services. MAIN OUTCOME MEASURES The outcomes included counseling experience on IUDs and implants, knowledge of patient eligibility, and clinician method skills. RESULTS At follow-up, providers were significantly more likely to report having enough experience to counsel on IUDs (adjusted odds ratio [aOR], 4.08; 95% confidence interval [CI], 2.62-6.36]) and implants (aOR, 3.06; 95% CI, 2.05-4.57). Provider knowledge about patient eligibility for IUDs, including for adolescents, increased (P < .001). Providers were more likely to offer same-visit IUD (aOR, 2.10; 95% CI, 1.41-3.12) and implant services (aOR, 1.66; 95% CI, 1.44-1.91). Clinicians' skills with contraceptive devices improved, including for a newly available low-cost IUD (aOR, 2.21; 95% CI, 1.45-3.36). CONCLUSIONS Offering evidence-based training is a promising approach to increase counseling and access to comprehensive contraceptive services at SBHCs.
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Affiliation(s)
- Alison B Comfort
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA.
| | - Lavanya Rao
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA
| | - Suzan Goodman
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA
| | - Angela Barney
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA
| | | | - Rosalyn Schroeder
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA
| | - Charles McCulloch
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA
| | - Cynthia C Harper
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA
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Dowell TL, Waters AM, Usher W, Farrell LJ, Donovan CL, Modecki KL, Zimmer-Gembeck MJ, Castle M, Hinchey J. Tackling Mental Health in Youth Sporting Programs: A Pilot Study of a Holistic Program. Child Psychiatry Hum Dev 2021; 52:15-29. [PMID: 32246362 DOI: 10.1007/s10578-020-00984-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Linking mental health services to organised sport offers an avenue to identify and improve mental health among adolescents. In this study, we investigated the efficacy, acceptability and feasibility of an integrated mental health system embedded within a junior sports development program. A three-step integrated mental health program for 12- to 15-year-old rugby league players (N = 74) was delivered in urban (n = 44) and rural (n = 33) areas. Specifically, this system (a) assessed participant mental health on primary outcome measures of anxiety, depression, and anger/conduct problems (and secondary outcome measures of personal attributes and relationships), (b) provided feedback to participants, parents and program coordinators, and (c) connected participants and parents to a multi-component intervention including online resources, a group-based workshop program (4 × 30-min sessions), and tailored individual-level follow-up and referral to further care for participants at high risk of mental health problems. From pre- to post-program, boys' anxiety symptoms declined significantly (with only a trend-level reduction in depression), and there were significant improvements in grit (for urban boys only), efficacy to manage negative emotions, and prosocial behaviour. In addition, when boys reported symptoms associated with high risk for mental health problems, providing parents with feedback enhanced boys' access to care and was associated with significant declines in anxiety symptoms. The program was generally acceptable and feasible, with very high retention in the youth sports development program. Overall, early findings support further deployment and evaluation of integrated mental health systems embedded within sporting contexts to address mental health problems among adolescent boys.
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Affiliation(s)
- Tiah L Dowell
- School of Applied Psychology, Griffith University, Mount Gravatt, Australia.
| | - Allison M Waters
- School of Applied Psychology, Griffith University, Mount Gravatt, Australia.
| | - Wayne Usher
- School of Applied Psychology, Griffith University, Mount Gravatt, Australia
| | - Lara J Farrell
- School of Applied Psychology, Griffith University, Mount Gravatt, Australia
| | - Caroline L Donovan
- School of Applied Psychology, Griffith University, Mount Gravatt, Australia
| | - Kathryn L Modecki
- School of Applied Psychology, Griffith University, Mount Gravatt, Australia
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Spencer AE, Valentine SE, Sikov J, Yule AM, Hsu H, Hallett E, Xuan Z, Silverstein M, Fortuna L. Principles of Care for Young Adults With Co-Occurring Psychiatric and Substance Use Disorders. Pediatrics 2021; 147:229-239. [PMID: 33386320 PMCID: PMC8276159 DOI: 10.1542/peds.2020-023523f] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/23/2020] [Indexed: 01/22/2023] Open
Abstract
Over 50% of young adults (defined as individuals aged 18-25 years) with substance use disorders (SUDs) have at least 1 co-occurring psychiatric disorder, and the presence of co-occurring disorders worsens SUD outcomes. Treatment of both co-occurring psychiatric disorders and SUDs in young adults is imperative for optimal treatment, yet many barriers exist to achieving this goal. We present a series of evidence-informed principles of care for young adults with co-occurring psychiatric disorders derived by a workgroup of experts convened by Boston Medical Center's Grayken Center for Addiction. The 3 principles are as follows: (1) young adults should receive integrated mental health and addiction care across treatment settings; (2) care should be responsive to the needs of young adults exposed to trauma and other adverse childhood experiences; and (3) treatment programs should regularly assess and respond to the evolving mental health needs, motivations, and treatment goals of young adults with co-occurring disorders. Our guidance for each principle is followed by a review of the evidence supporting that principle, as well as practice considerations for implementation. More research among young adults is critical to identify effective treatments and service systems for those with co-occurring disorders.
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Affiliation(s)
- Andrea E Spencer
- Departments of Psychiatry and
- Boston Medical Center, Boston, Massachusetts; and
| | - Sarah E Valentine
- Departments of Psychiatry and
- Boston Medical Center, Boston, Massachusetts; and
| | - Jennifer Sikov
- Departments of Psychiatry and
- Boston Medical Center, Boston, Massachusetts; and
| | - Amy M Yule
- Departments of Psychiatry and
- Boston Medical Center, Boston, Massachusetts; and
| | - Heather Hsu
- Boston Medical Center, Boston, Massachusetts; and
- Pediatrics, School of Medicine, and
| | | | - Ziming Xuan
- School of Public Health, Boston University, Boston, Massachusetts
| | - Michael Silverstein
- Boston Medical Center, Boston, Massachusetts; and
- Pediatrics, School of Medicine, and
| | - Lisa Fortuna
- Department of Psychiatry, University of California San Francisco, San Francisco, California
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Akseer N, Mehta S, Wigle J, Chera R, Brickman ZJ, Al-Gashm S, Sorichetti B, Vandermorris A, Hipgrave DB, Schwalbe N, Bhutta ZA. Non-communicable diseases among adolescents: current status, determinants, interventions and policies. BMC Public Health 2020; 20:1908. [PMID: 33317507 PMCID: PMC7734741 DOI: 10.1186/s12889-020-09988-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 11/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Addressing non-communicable disease (NCDs) is a global priority in the Sustainable Development Goals, especially for adolescents. However, existing literature on NCD burden, risk factors and determinants, and effective interventions and policies for targeting these diseases in adolescents, is limited. This study develops an evidence-based conceptual framework, and highlights pathways between risk factors and interventions to NCD development during adolescence (ages 10-19 years) and continuing into adulthood. Additionally, the epidemiologic profile of key NCD risk factors and outcomes among adolescents and preventative NCD policies/laws/legislations are examined, and a multivariable analysis is conducted to explore the determinants of NCDs among adolescents and adults. METHODS We reviewed literature to develop an adolescent-specific conceptual framework for NCDs. Global data repositories were searched from Jan-July 2018 for data on NCD-related risk factors, outcomes, and policy data for 194 countries from 1990 to 2016. Disability-Adjusted Life Years were used to assess disease burden. A hierarchical modeling approach and ordinary least squares regression was used to explore the basic and underlying causes of NCD burden. RESULTS Mental health disorders are the most common NCDs found in adolescents. Adverse behaviours and lifestyle factors, specifically smoking, alcohol and drug use, poor diet and metabolic syndrome, are key risk factors for NCD development in adolescence. Across countries, laws and policies for preventing NCD-related risk factors exist, however those targeting contraceptive use, drug harm reduction, mental health and nutrition are generally limited. Many effective interventions for NCD prevention exist but must be implemented at scale through multisectoral action utilizing diverse delivery mechanisms. Multivariable analyses showed that structural/macro, community and household factors have significant associations with NCD burden among adolescents and adults. CONCLUSIONS Multi-sectoral efforts are needed to target NCD risk factors among adolescents to mitigate disease burden and adverse outcomes in adulthood. Findings could guide policy and programming to reduce NCD burden in the sustainable development era.
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Affiliation(s)
- N. Akseer
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4 Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - S. Mehta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4 Canada
| | - J. Wigle
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4 Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - R. Chera
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4 Canada
| | - Z. J. Brickman
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4 Canada
| | - S. Al-Gashm
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4 Canada
| | - B. Sorichetti
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4 Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - A. Vandermorris
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4 Canada
- Division of Adolescent Medicine, Hospital for Sick Children, Toronto, Canada
| | | | | | - Z. A. Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4 Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan
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Anderson S, Haeder S, Caseman K, Mathur A, Ulmen K. When Adolescents are in School During COVID-19, Coordination Between School-Based Health Centers and Education is Key. J Adolesc Health 2020; 67:745-746. [PMID: 33059956 PMCID: PMC7550083 DOI: 10.1016/j.jadohealth.2020.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/03/2020] [Accepted: 09/06/2020] [Indexed: 11/16/2022]
Affiliation(s)
| | - Simon Haeder
- School of Public Policy, Pennsylvania State University, State College, Pennsylvania
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Saran A, White H, Albright K, Adona J. Mega-map of systematic reviews and evidence and gap maps on the interventions to improve child well-being in low- and middle-income countries. CAMPBELL SYSTEMATIC REVIEWS 2020; 16:e1116. [PMID: 37018457 PMCID: PMC8356294 DOI: 10.1002/cl2.1116] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND Despite a considerable reduction in child mortality, nearly six million children under the age of five die each year. Millions more are poorly nourished and in many parts of the world, the quality of education remains poor. Children are at risk from multiple violations of their rights, including child labour, early marriage, and sexual exploitation. Research plays a crucial role in helping to close the remaining gaps in child well-being, yet the global evidence base for interventions to meet these challenges is mostly weak, scattered and often unusable by policymakers and practitioners. This mega-map encourages the generation and use of rigorous evidence on effective ways to improve child well-being for policy and programming. OBJECTIVES The aim of this mega-map is to identify, map and provide an overview of the existing evidence synthesis on the interventions aimed at improving child well-being in low- and middle-income countries (LMICs). METHODS Campbell evidence and gap maps (EGMs) are based on a review of existing mapping standards (Saran & White, 2018) which drew in particular of the approach developed by 3ie (Snilstveit, Vojtkova, Bhavsar, & Gaarder, 2013). As defined in the Campbell EGM guidance paper; "Mega-map is a map of evidence synthesis, that is, systematic reviews, and does not include primary studies" (Campbell Collaboration, 2020). The mega-map on child well-being includes studies with participants aged 0-18 years, conducted in LMICs, and published from year 2000 onwards. The search followed strict inclusion criteria for interventions and outcomes in the domains of health, education, social work and welfare, social protection, environmental health, water supply and sanitation (WASH) and governance. Critical appraisal of included systematic reviews was conducted using "A Measurement Tool to Assess Systematic Reviews"-AMSTAR-2 rating scale (Shea, et al., 2017). RESULTS We identified 333 systematic reviews and 23 EGMs. The number of studies being published has increased year-on-year since 2000. However, the distribution of studies across World Bank regions, intervention and outcome categories are uneven. Most systematic reviews examine interventions pertaining to traditional areas of health and education. Systematic reviews in these traditional areas are also the most funded. There is limited evidence in social work and social protection. About 69% (231) of the reviews are assessed to be of low and medium quality. There are evidence gaps with respect to key vulnerable populations, including children with disabilities and those who belong to minority groups. CONCLUSION Although an increasing number of systematic reviews addressing child well-being topics are being published, some clear gaps in the evidence remain in terms of quality of reviews and some interventions and outcome areas. The clear gap is the small number of reviews focusing explicitly on either equity or programmes for disadvantaged groups and those who are discriminated against.
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Affiliation(s)
| | | | | | - Jill Adona
- Philippines Institute of Development StudiesManilaPhilippines
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35
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Folayan MO, Sam-Agudu NA, Adeniyi A, Oziegbe E, Chukwumah NM, Mapayi B. A proposed one-stop-shop approach for the delivery of integrated oral, mental, sexual and reproductive healthcare to adolescents in Nigeria. Pan Afr Med J 2020; 37:172. [PMID: 33447327 PMCID: PMC7778170 DOI: 10.11604/pamj.2020.37.172.22824] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/24/2020] [Indexed: 11/25/2022] Open
Abstract
The interconnectedness of oral, mental, sexual, and reproductive health (OMSRH) in adolescents prompts exploration of novel approaches to facilitate comprehensive access of this population to the relevant health services. This paper proposes an integrated one-stop-shop approach to increasing adolescents' access to OMSRH care by leveraging on dental clinics as a template for integration, using a non-stigmatized platform to deliver stigmatized healthcare. Novel healthcare delivery models are needed to enhance adolescents' access to the comprehensive prevention and treatment services that they critically need. Effective, integrated health care for this population is lacking, especially across various health areas. This is a proposal for leveraging dental clinics for integrated OMSRH care, using facility-based services, to adolescents. Emphasis will be placed on reducing stigma as a barrier to service accessibility, acceptability, equitability and appropriateness. Empirical studies will be required to test the feasibility, validity and effectiveness of this proposed model.
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Affiliation(s)
| | - Nadia Adjoa Sam-Agudu
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria.,Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA
| | - Abiola Adeniyi
- Faculty of Dentistry, Lagos State University College of Medicine, Lagos, Nigeria
| | - Elizabeth Oziegbe
- Department of Child Dental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Nneka Maureen Chukwumah
- Department of Preventive Dentistry, College of Medical Sciences, University of Benin, Benin City, Edo, Nigeria
| | - Boladale Mapayi
- Department of Mental Health, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
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McCann H, Moore MJ, Barr EM, Wilson K. Sexual Health Services in Schools: A Successful Community Collaborative. Health Promot Pract 2020; 22:349-357. [PMID: 31958977 DOI: 10.1177/1524839919894303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
School-based health centers (SBHCs) are an essential part of a comprehensive approach to address the health needs of youth. SBHCs that provide sexual health services (SHS) show promising results in improving reproductive health outcomes among youth. Despite the positive impact SBHCs can have, few school districts have SBHCs, and even fewer provide SHS. This article describes a successful 5-year project to provide SHS through SBHCs in a large county in the southeast United States. A community collaborative, including the schools, health department, community agencies and a local university, was created to address the project goals and objectives. Various steps were taken to plan for the SBHCs, including documenting community support for SHS offered through SBHCs, identifying school sites for SBHCs, and the process for offering pregnancy, STD (sexually transmitted disease), and HIV testing, treatment, and referrals. Protocols for clinic flow, testing, staffing, training, and student recruitment were developed. The staff at the SBHCs were successful in recruiting students to attend educational sessions and to receive testing and treatment. Student feedback was overwhelmingly positive. Lessons learned about the importance of the partnership's collaboration, using recommended clinic protocol, ensuring clear communication with school staff, and employing youth friendly recruitment and clinic practices are shared.
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Affiliation(s)
| | | | | | - Kristina Wilson
- Florida Department of Health in Duval County, Jacksonville, FL, USA
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Shabani O, Tshitangano TG. Determinants of the utilisation of sexual and reproductive healthcare services by male adolescents in the Tshwane Metropolitan Municipality in South Africa. Health SA 2020; 24:1203. [PMID: 31934432 PMCID: PMC6917445 DOI: 10.4102/hsag.v24i0.1203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 08/20/2019] [Indexed: 11/01/2022] Open
Abstract
Background Male adolescent sexual and reproductive health is one of the essential healthcare programmes in the world. However, male adolescents still face numerous challenges in this area. Determinants of the utilisation of these services need to be known to develop strategies to improve utilisation of the available services by male adolescents. Aim The aim of this study was to identify the determinants of the utilisation of sexual and reproductive healthcare services by male adolescents in the Tshwane Metropolitan Municipality in South Africa. Setting The study was conducted in the Tshwane Metropolitan Municipality in South Africa. Methods An explorative, descriptive and qualitative approach was employed. The study was contextual in nature, and purposive sampling was used. The population of the study consisted of male adolescents (aged 18-24 years) living in the Tshwane metropolitan Municipality. Twenty male adolescents participated in the study. Data collected using semistructured individual interviews were analysed using Tesch's method of data analysis, and measures to ensure trustworthiness and ethical consideration pertaining to the study were established. Results The perception of existing services was found to be a significant individual factor influencing them negatively in utilising the services. This was linked to the violation of their rights as human beings by healthcare providers, their unmet expressed needs and the ineffectiveness as well as inefficiency of the support structures. Conclusion These results suggest that utilisation of these services by male adolescents can be improved by changing their perception of the existing services through support from different structures of the society.
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Affiliation(s)
- Omari Shabani
- Department of Public Health, School of Health Sciences, University of Venda, Thohoyandou, South Africa
| | - Takalani G Tshitangano
- Department of Public Health, School of Health Sciences, University of Venda, Thohoyandou, South Africa
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Fisher R, Danza P, McCarthy J, Tiezzi L. Provision of Contraception in New York City School-Based Health Centers: Impact on Teenage Pregnancy and Avoided Costs, 2008-2017. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2019; 51:201-209. [PMID: 31840909 DOI: 10.1363/psrh.12126] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 04/07/2019] [Accepted: 07/17/2019] [Indexed: 06/10/2023]
Abstract
CONTEXT Since 2008, the School-Based Health Center Reproductive Health Project (SBHC RHP) has supported SBHCs in New York City (NYC) to increase the availability of effective contraception; however, its impact on teenage pregnancy and avoided costs has not been estimated. METHODS The impact of the SBHC RHP on patterns of contraceptive use and on the numbers of pregnancies, abortions and births averted in 2008-2017 was estimated using program data and public data from the NYC Bureau of Vital Statistics and Youth Risk Behavior Survey. Data from the Guttmacher Institute on the cost of publicly funded births and abortions were used to estimate costs avoided; NYC-specific teenage pregnancy outcome data were employed to estimate the proportion of overall declines attributable to the SBHC RHP. RESULTS Between 2008 and 2017, the SBHC RHP supported a substantial increase in the proportion of sexually active female clients using effective contraceptives. Most dramatically, 14% of clients in the SBHC RHP method mix used LARCs in 2017, compared with 2% in the non-SBHC RHP mix. The project averted an estimated 5,376 pregnancies, 2,104 births and 3,085 abortions, leading to an estimated $30,360,352 in avoided one-time costs of publicly funded births and abortions. These averted events accounted for 26-28% of the decline in teenage pregnancies, births and abortions in NYC. CONCLUSIONS When comprehensive reproductive health services are available in SBHCs, teenagers use them, resulting in substantially fewer pregnancies, abortions and births, and lower costs to public health systems.
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Affiliation(s)
- Rebecca Fisher
- The Office of School Health, New York City Department of Health and Mental Hygiene, New York
| | - Phoebe Danza
- The Office of School Health, New York City Department of Health and Mental Hygiene, New York
| | - James McCarthy
- Marxe School of Public and International Affairs, Baruch College, The City University of New York, New York
| | - Lorraine Tiezzi
- The Office of School Health, New York City Department of Health and Mental Hygiene, New York
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Doyle AM, Mchunu L, Koole O, Mthembu S, Dlamini S, Ngwenya N, Ferguson J, Seeley J. Primary healthcare and school health service utilisation by adolescents and young adults in KwaZulu-Natal, South Africa. BMC Health Serv Res 2019; 19:905. [PMID: 31779631 PMCID: PMC6883644 DOI: 10.1186/s12913-019-4559-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 09/25/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Young people aged 10-24 years are a vulnerable group with poor health service access relative to other populations. Recent South African initiatives, the She Conquers campaign, the Integrated School Health Policy and the Adolescent & Youth Health Policy, include a focus on improving the breadth and quality of youth-friendly health service delivery. However, in some settings the provision and impact of scaled-up youth friendly health services has been limited indicating a gap between policy and implementation. In this study we reviewed existing sources of data on health service utilisation to answer the following question: 'What health conditions do young people present with and what services do they receive at public health clinics, mobile clinics and school health services?' METHODS We conducted a retrospective register review in three purposively selected primary healthcare clinics (PHCC), one mobile clinic, and one school health team in Hlabisa and Mtubatuba sub-districts of uMkhanyakude District, KwaZulu-Natal, South Africa. The focus was service utilisation for any reason by 10-24 year olds. We also conducted descriptive analysis of pre-existing data on service utilisation by young people available from the District Health Information System for all 17 PHCC in the study sub-districts. RESULTS Three quarters of 4121 recorded young person visits in the register review were by females, and 40% of all young person visits were by females aged 20-24 years. The most common presenting conditions were HIV-related, antenatal care, family planning, general non-specific complaints and respiratory problems (excluding TB). There were relatively few recorded consultations for other common conditions affecting young people such as mental health and nutritional problems. Antibiotics, antiretrovirals, contraceptives, vitamins/supplements, and analgesics were most commonly provided. Routine health registers recorded limited information, were often incomplete and/or inconsistent, and age was not routinely recorded. CONCLUSIONS Measuring morbidity and service provision are fundamental to informing policy and promoting responsive health systems. Efforts should be intensified to improve the quality and completeness of health registers, with attention to the documentation of important, and currently poorly documented, young people's health issues such as mental health and nutrition.
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Affiliation(s)
- Aoife M. Doyle
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Lerato Mchunu
- Africa Health Research Institute, Durban, KwaZulu-Natal South Africa
| | - Olivier Koole
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
- Africa Health Research Institute, Durban, KwaZulu-Natal South Africa
| | - Sandile Mthembu
- Africa Health Research Institute, Durban, KwaZulu-Natal South Africa
| | | | - Nothando Ngwenya
- Africa Health Research Institute, Durban, KwaZulu-Natal South Africa
| | - Jane Ferguson
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
- Africa Health Research Institute, Durban, KwaZulu-Natal South Africa
| | - Janet Seeley
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
- Africa Health Research Institute, Durban, KwaZulu-Natal South Africa
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Carr KL, Stewart MW. Effectiveness of School-based Health Center Delivery of a Cognitive Skills Building Intervention in Young, Rural Adolescents: Potential Applications for Addiction and Mood. J Pediatr Nurs 2019; 47:23-29. [PMID: 31022629 DOI: 10.1016/j.pedn.2019.04.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 04/11/2019] [Accepted: 04/12/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Uniquely positioned, school nurses address two of the most critical adolescent health issues - addiction and mood. Cognitive behavioral therapy, the mainstay in management of adolescent mood disorders, demonstrates promise in the treatment and prevention of addictive behaviors. Quality decision-making may protect adolescents from substance abuse. Executive function, a neurocognitive aspect of decision-making, involves impulse control, future thinking, and behavioral regulation. Further, the continuum of addition implicates executive function, which makes executive function a viable target for prevention and treatment of substance use. This pilot study examined the effectiveness of a nurse-led cognitive skills training intervention, Creating Opportunities for Personal Empowerment, on executive function and mood in a novel population and setting. DESIGN AND METHODS The study sample included adolescents ranging in age from 12 to 15 years and enrolled in a rural school-based health center. Fifteen (n = 15) adolescents completed the seven-week cognitive skills building intervention led by a nurse practitioner. Researchers measured executive function, anxiety, and depression at: baseline, after the intervention series, and three-months later. RESULTS One domain of executive function - behavioral regulation - improved, as did anxiety. Depression showed short-term improvement. Metacognition did not change over time. CONCLUSIONS Preliminary results indicate that cognitive skills building delivered by school nurses may enhance aspects of executive function linked with addiction and coping, such as behavioral regulation. Further, this intervention may also improve mood in this population. PRACTICE IMPLICATIONS Delivery of cognitive skills training by school nurses could be an accessible, effective piece in addressing addiction and mood in young, rural adolescents.
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Affiliation(s)
- Kayla L Carr
- University of Mississippi Medical Center, MS, United States of America.
| | - Mary W Stewart
- University of Mississippi Medical Center, MS, United States of America.
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Effectiveness of School-Based Teen Pregnancy Prevention Programs in the USA: a Systematic Review and Meta-Analysis. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2019; 19:468-489. [PMID: 29374797 DOI: 10.1007/s11121-017-0861-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
School-based programs have been a mainstay of youth pregnancy prevention efforts in the USA. We conducted a systematic review and meta-analysis to assess their effectiveness. Eligible studies evaluated the effect on pregnancy rates of programs delivered in elementary, middle, or high schools in the USA and Canada, published between January 1985 and September 2016. The primary outcome was pregnancy; secondary outcomes were delay in sexual initiation, condom use, and oral contraception use. Randomized controlled trials (RCTs) and non-RCTs with comparator groups were eligible. We developed a comprehensive search strategy, applied to major bibliographic databases, article bibliographies, gray literature, and contact with authors. We calculated risk ratios (RR) with 95% confidence intervals (CI) for each outcome and pooled data in random effects meta-analysis. We used Grading of Recommendations Assessment, Development and Evaluation (GRADE) to assess evidence quality. Ten RCTs and 11 non-RCTs conducted from 1984 to 2016 yielded 30 unique pooled comparisons for pregnancy, of which 24 were not statistically significant. Six showed statistically significant changes in pregnancy rates: two with increased risk (RR 1.30, 95% CI 1.02-1.65; and RR 1.39, 95% CI 1.10-1.75) and four with decreased risk ranging from RR 0.56, 95% CI 0.41-0.77, to RR 0.75, 95% CI 0.58-0.96. All studies were at high risk of bias, and the quality of evidence was low or very low. Identified evidence indicated no consistent difference in rates of pregnancies between intervention recipients and controls.
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Mirzazadeh A, Biggs MA, Viitanen A, Horvath H, Wang LY, Dunville R, Barrios LC, Kahn JG, Marseille E. Do School-Based Programs Prevent HIV and Other Sexually Transmitted Infections in Adolescents? A Systematic Review and Meta-analysis. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2019; 19:490-506. [PMID: 28786046 DOI: 10.1007/s11121-017-0830-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We systematically reviewed the literature to assess the effectiveness of school-based programs to prevent HIV and other sexually transmitted infections (STI) among adolescents in the USA. We searched six databases including PubMed for studies published through May 2017. Eligible studies included youth ages 10-19 years and assessed any school-based programs in the USA that reported changes in HIV/STI incidence or testing. We used Cochrane tool to assess the risk of bias and GRADE to determine the evidence quality for each outcome. Three RCTs and six non-RCTs, describing seven interventions, met study inclusion criteria. No study reported changes in HIV incidence or prevalence. One comprehensive intervention, assessed in a non-RCT and delivered to pre-teens, reduced STI incidence into adulthood (RR 0.36, 95% CI 0.23-0.56). A non-RCT examining chlamydia and gonorrhea incidence before and after a condom availability program found a significant effect at the city level among young men 3 years later (RR 0.43, 95% CI 0.23-0.80). The remaining four interventions found no effect. The effect on STI prevalence was also not significant (pooled RR 0.83 from two non-RCTs, RR 0.70 from one RCT). Only one non-RCT showed an increase in HIV testing (RR 3.19, 95% CI 1.24-8.24). The quality of evidence for all outcomes was very low. Studies, including the RCTs, were of low methodological quality and had mixed findings, thus offering no persuasive evidence for the effectiveness of school-based programs. The most effective intervention spanned 6 years, was a social development-based intervention with multiple components, rather than a sex education program, and started in first grade.
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Affiliation(s)
- Ali Mirzazadeh
- School of Medicine, Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA. .,Global Health Sciences, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA.
| | - M Antonia Biggs
- Department of Obstetrics, Gynecology and Reproductive Sciences, Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA, 94612, USA
| | - Amanda Viitanen
- Global Health Sciences, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA
| | - Hacsi Horvath
- School of Medicine, Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA.,Global Health Sciences, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA
| | - Li Yan Wang
- Division of Adolescent and School Health, U.S. Centers for Disease Control and Prevention, Office of Infectious Diseases, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, GA, 30329, USA
| | - Richard Dunville
- Division of Adolescent and School Health, U.S. Centers for Disease Control and Prevention, Office of Infectious Diseases, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, GA, 30329, USA
| | - Lisa C Barrios
- Division of Adolescent and School Health, U.S. Centers for Disease Control and Prevention, Office of Infectious Diseases, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, GA, 30329, USA
| | - James G Kahn
- Global Health Sciences, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA.,Global Health Economics Consortium, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA
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Denny S, Grant S, Galbreath R, Utter J, Fleming T, Clark T. An observational study of adolescent health outcomes associated with school-based health service utilization: A causal analysis. Health Serv Res 2019; 54:678-688. [PMID: 30883726 PMCID: PMC6505405 DOI: 10.1111/1475-6773.13136] [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: 11/29/2022] Open
Abstract
OBJECTIVE Our aim is to examine the unbiased association between use of school-based health services (SBHS) and student health outcomes. DATA SOURCES Data are from a nationally representative health and well-being survey of 8500 New Zealand high school students from 91 high schools. STUDY DESIGN Student data were linked to the level of SBHS available to them: no SBHS, regular clinics from visiting health professionals, a health professional onsite, or a health team onsite. DATA COLLECTION/EXTRACTION METHODS Causal analyses are used to compare utilization of SBHS and their association with student-reported health outcomes, including foregone health care, depressive symptoms, emotional and behavioral difficulties, suicide risk, substance use, and unsafe sexual behaviors. PRINCIPAL FINDINGS Results from the multinomial propensity score-weighted regressions show that the use of SBHS was associated with poorer health outcomes, suggesting that selection bias was present due to unmeasured confounders. Instrumental variable analyses found that that students using team-based SBHS had a 4.7 percent (95% CI 0.5-8.9) probability of high levels of depressive symptoms compared to 14.2 percent (95% CI 11.5-16.8) among students not using team SBHS. For suicide attempt, students using team-based SBHS had a 2.0 percent (95% CI -0.3-4.2) probability of a suicide attempt in the previous 12 months compared to 5.6 percent (95% CI 2.6-8.5) among students not using team SBHS. CONCLUSIONS These analyses suggest that team-based SBHS are associated with better mental health among students who attend them.
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Affiliation(s)
- Simon Denny
- Department of Paediatrics, Child and Youth HealthUniversity of AucklandAucklandNew Zealand
| | - Sue Grant
- Department of Paediatrics, Child and Youth HealthUniversity of AucklandAucklandNew Zealand
| | - Ross Galbreath
- Department of Paediatrics, Child and Youth HealthUniversity of AucklandAucklandNew Zealand
| | - Jennifer Utter
- School of Population HealthUniversity of AucklandAucklandNew Zealand
| | - Theresa Fleming
- Faculty of HealthVictoria University of WellingtonWellingtonNew Zealand
| | - Terryann Clark
- School of NursingFaculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
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Acceptability and feasibility of a school-based contraceptive clinic in a low-income community in South Africa. Prim Health Care Res Dev 2019; 20:e22. [PMID: 32799997 PMCID: PMC6476342 DOI: 10.1017/s1463423618000762] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim To investigate how acceptable and feasible a school-based contraceptive clinic (SBCC) would be in a low-income South African community. Background Teenage pregnancy is an important issue in South Africa, with significant health and social consequences. Issues regarding lack of confidentiality in an intimate community, unwelcoming health workers, long distances to clinics and perceptions of contraceptive side effects may all inhibit contraceptive use by adolescents. Although SBCC has been initiated and investigated in other countries, this approach is inadequately researched in South Africa. Methods A mixed method study was conducted to assess the attitudes of one community towards establishment of an SBCC in their area. Methods of data collection included: focus group discussions (FGDs) with teenage girls from a local high school; a key informant interview with the school principal; a structured survey, including open-ended questionnaires with randomly selected parents of teenage girls from the same community; and a documentary analysis to explore relevant legal and policy considerations. Findings Teenage girls, the school principal and parents with teenage daughters largely supported the idea of an SBCC, but with concerns about confidentiality, the possibility of increased promiscuity and contraceptive side effects. While legal statutes and policies in South Africa do not pose any barriers to the establishment of an SBCC, some logistical barriers remain.
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de Looze M, Madkour AS, Huijts T, Moreau N, Currie C. Country-Level Gender Equality and Adolescents' Contraceptive Use in Europe, Canada and Israel: Findings from 33 Countries. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2019; 51:43-53. [PMID: 30817858 PMCID: PMC6996477 DOI: 10.1363/psrh.12090] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 11/21/2018] [Accepted: 11/26/2018] [Indexed: 05/30/2023]
Abstract
CONTEXT Although an association between gender equality and contraceptive use has been confirmed among adult samples, few studies have explored this relationship among adolescents. An examination of whether adolescents' contraceptive use is more prevalent in countries with higher levels of gender equality is needed to fill this gap. METHODS Nationally representative data from 33 countries that participated in the 2013-2014 Health Behaviour in School-Aged Children study and country-level measures of gender equality-using the 2014 Global Gender Gap Index-were analyzed. Multilevel multinomial logistic regression analyses were employed to assess associations between gender equality and contraceptive use (condom only, pill only and dual methods) at last intercourse as reported by 4,071 females and 4,110 males aged 14-16. RESULTS Increasing gender equality was positively associated with contraceptive use among both males and females. For every 0.1-point increase on the equality scale, the likelihood of condom use at last intercourse rose (odds ratio, 2.1 for females), as did the likelihood of pill use (6.5 and 9.6, respectively, for males and females) and dual method use (2.1 and 5.6, respectively). Associations with pill use and dual use remained significant after national wealth and income inequality were controlled for. Overall, associations were stronger for females than for males. CONCLUSIONS More research is needed to identify potential causal pathways and mechanisms through which gender equality and adolescents' contraceptive use may influence one another.
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Affiliation(s)
- Margaretha de Looze
- Assistant professor, Department of Inter disciplinary Social Science, Faculty of Social and Behavioural SciencesUtrecht UniversityUtrechtthe Netherlands
| | - Aubrey S. Madkour
- Associate professor, Department of Global Community Health and Behavioral SciencesTulane University School of Public Health and Tropical MedicineNew Orleans
| | - Tim Huijts
- Researcher, Research Centre for Education and the Labour Market, School of Business and EconomicsMaastricht UniversityMaastrichtthe Netherlands
| | - Nathalie Moreau
- Researcher, Service d'Information Promotion Education Santé, School of Public HealthUniversité Libre de BruxellesBrusselsBelgium
| | - Candace Currie
- Professor, Child and Adolescent Health Research Unit, WHO Collaborating Centre for International Child and Adolescent Health Policy, School of MedicineUniversity of St. AndrewsSt. AndrewsScotland
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Academic, Psychosocial, and Demographic Correlates of School-Based Health Center Utilization: Patterns by Service Type. CHILD & YOUTH CARE FORUM 2019. [DOI: 10.1007/s10566-019-09495-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Arenson M, Hudson PJ, Lee N, Lai B. The Evidence on School-Based Health Centers: A Review. Glob Pediatr Health 2019; 6:2333794X19828745. [PMID: 30815514 PMCID: PMC6381423 DOI: 10.1177/2333794x19828745] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 12/16/2018] [Accepted: 12/18/2018] [Indexed: 11/18/2022] Open
Abstract
Context. Pediatricians working toward health equity require health care delivery mechanisms that take on dual roles: mitigating the health effects of a maladaptive social ecosystem while simultaneously working to improve the ecosystem itself. School-based health centers (SBHCs) perform these dual roles by providing medical, mental/behavioral, dental, and vision care directly in schools where young people spend the majority of their time, maximizing their opportunity to learn and grow. Evidence Acquisition. Databases were searched extensively for research studies published between January 2000 and December 2018. Evidence Synthesis. The authors began with 3 recent high-impact reviews that covered SBHC history, health outcomes, cost-benefit, and impact on health equity. Informed by these articles, the authors organized the evidence into 4 broad categories of impact: Financial, Physical Health (including medical, vision, and dental), Mental Health, and Educational Outcomes. Using these 4 categories, the authors then performed a robust literature search using PubMed for studies that fit into these themes. Conclusions. SBHCs increase access to health services for children, families, and communities, which ultimately leads to positive short- and long-term outcomes in service of a broad range of stakeholders. Educational impact requires further attention on both outcomes and methodological approaches. Three current public health topics of importance were identified that SBHCs might be well-suited to address: Youth Gun Violence, Adverse Childhood Experiences, and the Health of American Indian/Alaskan Native communities in the United States.
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Affiliation(s)
| | | | | | - Betty Lai
- Boston College, Chestnut Hill, MA, USA
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STI Health Disparities: A Systematic Review and Meta-Analysis of the Effectiveness of Preventive Interventions in Educational Settings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15122819. [PMID: 30544919 PMCID: PMC6313766 DOI: 10.3390/ijerph15122819] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 12/08/2018] [Accepted: 12/09/2018] [Indexed: 12/04/2022]
Abstract
The purpose of this systematic review and meta-analysis was to address disparities related to sexual health among students by examining the effectiveness of sexually transmitted infection (STI) preventive interventions in educational settings. PubMed, Medline, Cochrane Library, Public Health Database, and EMBASE databases were used to conduct searches. Information relating to studies, programs, participants, and quantitative outcome variables were extracted. Risk of bias was assessed and meta-analysis was conducted. This systematic review included 16 articles. The outcomes were classified into behavioral and psychosocial categories. The behavioral category included sexual partners, sexual activity, condom use, STI/HIV testing, and alcohol/drug use before sex. The psychosocial category consisted of knowledge, motivational factors, and skills. Interventions had a significantly positive impact on both behavioral (OR, 1.28; 95% CI, 1.17–1.39) and psychosocial (OR, 1.92; 95% CI, 1.36–2.72) outcomes. Among the psychosocial outcomes, the interventions were most effective at promoting knowledge (OR, 3.17; 95% CI, 2.13–4.72), followed by enhancing motivational factors (OR, 1.69; 95% CI, 1.04–2.75) and increasing behavioral skills (OR, 1.43; 95% CI, 1.13–1.81). The results of this systematic review provide empirical evidence for public health professionals and policy makers regarding planning, implementation, evaluation, and modification of STI preventive intervention programs in educational settings.
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Hardin HK, McCarthy VL, Speck BJ, Crawford TN. Diminished Trust of Healthcare Providers, Risky Lifestyle Behaviors, and Low Use of Health Services: A Descriptive Study of Rural Adolescents. J Sch Nurs 2018; 34:458-467. [PMID: 28823198 PMCID: PMC5629118 DOI: 10.1177/1059840517725787] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The purpose of our study was to determine the extent to which individual characteristic variables predict trust of healthcare provider (HCP), lifestyle behaviors, and use of health services among adolescents attending public high school in rural Indiana. The sample included 224 individuals surveyed in 9th grade or 12th grade required courses. Trust of HCP and lifestyle behaviors were predicted using hierarchical multiple regression; number of HCP visits and emergency department (ED) visits in the past 12 months were predicted using negative binomial regression. This sample of adolescents living in a rural area reported riskier lifestyle behaviors than another sample of adolescents, lower trust of HCP than adults in general, and fewer HCP and ED visits than adolescents in general. Our study supports the need for school-based health services in rural areas and the opportunity for school nurses to act as care coordinators for marginalized youth.
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Affiliation(s)
- Heather K. Hardin
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | | | - Barbara J. Speck
- School of Nursing, University of Louisville, Louisville, KY, USA
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Nacken A, Rehfuess EA, Paul I, Lupapula A, Pfadenhauer LM. Teachers' competence, school policy and social context-HIV prevention needs of primary schools in Kagera, Tanzania. HEALTH EDUCATION RESEARCH 2018; 33:505-521. [PMID: 31222361 DOI: 10.1093/her/cyy036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 08/05/2018] [Accepted: 09/17/2018] [Indexed: 06/09/2023]
Abstract
Sub-Saharan Africa carries a high burden of the HIV epidemic, with young adults being particularly affected. Well-designed school-based HIV prevention interventions can contribute to establishing protective behaviour. The aim of this study was to explore the needs of primary school students and teachers in the region of Kagera, Tanzania, regarding an HIV prevention intervention in the primary school setting. The needs assessment was structured according to the PRECEDE component of the PRECEDE-PROCEED model. Qualitative data was collected in six focus group discussions with primary school students and teachers. Key informant interviews with seven experts were conducted. We employed qualitative content analysis to analyse data in MAXQDA. The findings suggest that teachers need to be adequately trained to provide HIV and sex education and to support HIV-positive students. Enabling structural factors, such as an appropriate syllabus, are required. Stigmatization has been reported a major barrier to HIV prevention in schools. Teachers and students identified a more trustful relationship between each other as well as to legal guardians of children as a basis for HIV prevention. These findings will inform the development of a tailored HIV prevention intervention.
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Affiliation(s)
- A Nacken
- Pettenkofer School of Public Health, Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Marchioninistr. 15, Munich, Germany
| | - E A Rehfuess
- Pettenkofer School of Public Health, Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Marchioninistr. 15, Munich, Germany
| | - I Paul
- Jambo Bukoba NGO Office Tanzania, Jambo Bukoba e.V., Aerodrome Road, Bukoba, Tanzania
| | - A Lupapula
- Department of Kiswahili, St. Augustine University of Tanzania, Mwanza, Tanzania
| | - L M Pfadenhauer
- Pettenkofer School of Public Health, Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Marchioninistr. 15, Munich, Germany
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