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Maier MC, Scharf JY, Gold MA, Ancheta AJ, Bruzzese JM, Garbers S. 'Our mind could be our biggest challenge': A qualitative analysis of urban adolescents' sleep experiences and opportunities for mind-body integrative health approaches to improve sleep. PEC Innov 2023; 2:100130. [PMID: 37214498 PMCID: PMC10194289 DOI: 10.1016/j.pecinn.2023.100130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 05/24/2023]
Abstract
Objective To inform the development of a combined sleep and mind-body integrative health (MBIH) intervention, we explored urban adolescents' sleep experiences and perceptions of MBIH techniques. Methods We conducted eight focus groups with school-based health center patients in New York City, exploring sleep experiences; mindfulness, body awareness, tapping, acupressure, and self-hypnosis; and intervention delivery preferences. We recorded, transcribed, and analyzed the discussions applying methods from grounded theory. Results Participants (n = 25) were ages 14-17, predominantly female (64%), Latino (60%), and Black (40%). Participants reported social, physical, and internal sleep barriers, but had limited success implementing sleep improvement strategies. Participants viewed MBIH techniques positively, noted audio-guided techniques' accessibility, and were intrigued by less-familiar techniques. Preferences varied around domains of intervention delivery. Conclusion Results underscore the need for adolescent-informed interventions offering sleep improvement strategies. Participants' interest and willingness to engage in MBIH techniques present an opportunity for practitioners to develop and deliver sleep interventions incorporating MBIH components to urban adolescents. Varied intervention preferences highlight the need to be adaptable to adolescents' lived experiences, comfort levels, and learning styles. Innovation This study elucidates the perspectives of underrepresented adolescents whose perspectives on MBIH have rarely been explored, an important first step in developing tailored interventions.
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Affiliation(s)
- Malia C. Maier
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Jodi Y. Scharf
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Melanie A. Gold
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
- School-Based Health Centers, New York-Presbyterian, USA
| | | | | | - Samantha Garbers
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
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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] [What about the content of this article? (0)] [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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Lee J, Bifano SM, Bombacie MJ, Lakhaney D, Steinberg DM, Gangopadhyay M, Porter R, Stenglein SL, Gold MA. The Development of a Multidisciplinary Support Network to Support Hospitalized Pediatric Patients, Their Families, and Hospital Staff During the COVID-19 Pandemic. Med Acupunct 2023; 35:180-185. [PMID: 37609551 PMCID: PMC10440643 DOI: 10.1089/acu.2023.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023] Open
Abstract
Background The COVID-19 pandemic led to emotional and behavioral challenges for hospitalized pediatric patients, their families, and staff. Visitor restrictions, closure of patient lounges and playrooms, masking requirements, and enhanced isolation rules resulted in limited access to typical sources of psychosocial support during this traumatic event. Complementary and integrative health therapies such as acupuncture and related therapies are well suited to provide the humanitarian support patients and families need during times of crisis. Objective The Multidisciplinary Support Network (i.e., Network) was formed to redesign the delivery of acupuncture and other integrative therapies alongside psychosocial support for hospitalized children, their families, and staff. Intervention Network members represented a broad range of previously siloed disciplines including integrative therapies, art therapy, child life, nursing, pastoral care, adolescent medicine, pediatric hospital medicine, psychology, and child and adolescent psychiatry. The Network aimed to identify gaps in service and create resources to support children and families during this challenging time. Results The Network compiled existing complementary and integrative services, provided training on integrative therapies to staff, pediatric trainees, and faculty, developed the Comfort Box containing items to provide symptom relief including pain, anxiety and difficulty sleeping, as well as closed-circuit programming, a pediatric companionship program connecting medical student volunteer companions with pediatric patients, and a well-being workbook. Conclusion Collaborative teamwork across disciplines using integrative therapies was key to humanitarian efforts to support hospitalized children and their families during this crisis.
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Affiliation(s)
- Jennifer Lee
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Morgan Stanley Children's Hospital, NewYork-Presbyterian, New York, NY, USA
| | - Susanne M. Bifano
- Morgan Stanley Children's Hospital, NewYork-Presbyterian, New York, NY, USA
| | - Michelle J. Bombacie
- Division of Hematology, Oncology and Stem Cell Transplantation, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Divya Lakhaney
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Morgan Stanley Children's Hospital, NewYork-Presbyterian, New York, NY, USA
| | - Dara M. Steinberg
- Division of Hematology, Oncology and Stem Cell Transplantation, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Maalobeeka Gangopadhyay
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Rechelle Porter
- UCSF Benioff Children's Hospital of Oakland California, Oakland, CA, USA
| | - Stacy L. Stenglein
- Morgan Stanley Children's Hospital, NewYork-Presbyterian, New York, NY, USA
| | - Melanie A. Gold
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY, USA
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Garbers S, Ancheta AJ, Gold MA, Maier M, Bruzzese JM. Sleeping Healthy, Living Healthy: Using Iterative, Participatory Processes to Develop and Adapt an Integrated Sleep Hygiene/Mind-Body Integrative Health Intervention for Urban Adolescents. Health Promot Pract 2023:15248399231184453. [PMID: 37491898 PMCID: PMC10808277 DOI: 10.1177/15248399231184453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
Racial and ethnic minority adolescents living in urban settings experience sleep disparities. Few interventions have been developed to address these disparities. Guided by principles of participatory design and inclusion, our team developed a novel intervention that combined sleep hygiene education with mind-body integrative health (MBIH) practices to improve sleep quality among adolescents in New York City. The goal of this article is to describe our iterative development and design process, the final product, and future directions. Our participatory approach incorporated information from formative work with adolescents having lived experience, practitioners, and syntheses of published literature. The final intervention-Sleeping Healthy, Living Healthy-consists of six, 40-minute group sessions and one 20-minute individual session designed for high school students. Each session has a set of learning objectives, combining instruction, group activities, and discussions on sleep hygiene and MBIH topics. Our manualized intervention includes handouts created by a graphic design team that served as a review and reminder for home practice. We describe intervention implementation to two unique cohorts and detail our methods used to fine-tune the intervention between cohorts. Our partnership with and insights from both adolescents and practitioners serve as a guide for researchers aiming to use participatory methods to develop interventions to decrease health disparities in specific populations.
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Affiliation(s)
- Samantha Garbers
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - April J. Ancheta
- University of Pennsylvania, Philadelphia, PA, USA
- Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Melanie A. Gold
- Columbia University Mailman School of Public Health, New York, NY, USA
- NewYork-Presbyterian, New York, NY USA
| | - Malia Maier
- Columbia University Mailman School of Public Health, New York, NY, USA
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Durante JC, Sims J, Jarin J, Gold MA, Messiah SE, Francis JKR. Long-Acting Reversible Contraception for Adolescents: A Review of Practices to Support Better Communication, Counseling, and Adherence. Adolesc Health Med Ther 2023; 14:97-114. [PMID: 37181329 PMCID: PMC10167958 DOI: 10.2147/ahmt.s374268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/12/2023] [Indexed: 05/16/2023] Open
Abstract
Long-acting reversible contraception (LARC) methods, including levonorgestrel and copper intrauterine devices (IUDs) and the subdermal contraceptive implant, are the most effective reversible forms of contraception and thus are an important aspect of adolescent pregnancy prevention. While LARC efficacy, safety, and appropriateness are supported by major medical organizations and usage rates are increasing, overall LARC uptake among United States (US) adolescents remains lower than uptake of short-acting contraceptive methods. A better understanding of the barriers affecting adolescent LARC uptake and reasons for discontinuation could help facilitate effective communication. For example, learning how to improve adolescent-centered communication, shared decision-making, and motivational counseling strategies may be the first step to improving utilization rates. This narrative review includes three sections. First, this review will describe the history, mechanisms of action, and epidemiology of adolescent LARC use in the US and globally. Next, this review will describe key factors influencing adolescent LARC uptake, reasons for discontinuation, and multilevel barriers specific to adolescent LARC use. Finally, this review will characterize communication techniques and LARC counseling strategies for adolescents in the context of a reproductive justice approach set in the health belief model framework. The distinction between moving away from a presumptive counseling approach towards an adolescent-centered, shared decision-making approach to encourage parent-adolescent sexual health communication to lay the foundation of empowering adolescent reproductive autonomy should be the underpinning of all effective reproductive communication strategies.
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Affiliation(s)
- Julia C Durante
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Children’s Health System of Texas, Dallas, TX, USA
| | - Jessica Sims
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Children’s Health System of Texas, Dallas, TX, USA
| | - Jason Jarin
- Children’s Health System of Texas, Dallas, TX, USA
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Melanie A Gold
- Department of Pediatrics and Department of Population & Family Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Sarah E Messiah
- University of Texas Health Science Center at Houston, School of Public Health, Dallas Campus, Dallas, TX, USA
- Center for Pediatric and Population Health, UTHealth School of Public Health, Dallas, TX, USA
- Department of Pediatrics, McGovern Medical School, Houston, TX, USA
| | - Jenny K R Francis
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Children’s Health System of Texas, Dallas, TX, USA
- Peter O’Donnell School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Garbers S, Umar NQ, Hand RE, Usseglio J, Gold MA, Bruzzese JM. Mind-Body Integrative Health (MBIH) Interventions for Sleep among Adolescents: A Scoping Review of Implementation, Participation and Outcomes. Adolesc Res Rev 2022; 7:565-589. [PMID: 36619475 PMCID: PMC9815202 DOI: 10.1007/s40894-021-00176-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/24/2021] [Indexed: 05/17/2023]
Abstract
Adolescents get insufficient sleep, adversely affecting health. Mind-body integrative health interventions for adolescents have been shown to reduce stress, a barrier to good sleep. This scoping review aimed to synthesize mind-body integrative health interventions for adolescents, how interventions were implemented, who was reached. A systematic search of four online databases was conducted. Randomized, quasi-experimental, and single-group designs with participants ages 10-24 years were included. Twelve studies covering 10 interventions using mindfulness, qigong, aromatherapy, or yoga were identified. Participants were predominantly female; only one study reported participants' race or ethnicity (81% non-Hispanic white). Most (n=6) interventions were delivered in groups, and half reported significant improvements in subjective sleep quality. Mindfulness-based stress reduction and mindfulness-based cognitive therapy were the most commonly used modalities, with reported impact on sleep outcomes measured objectively. The two interventions that found statistically significant, moderate improvements in objectively-measured sleep onset latency and sleep efficiency were of higher intensity and used mindfulness. Four interventions were self-directed; participants in these struggled with adherence; significant impacts on sleep were not found. While findings were mixed, stemming in part from the quality of the underlying studies, this review identified several promising features of interventions, including using mindfulness, ensuring sufficient intervention dose, and targeting interventions towards adolescents with poor sleep at baseline (rather than a general population of adolescents). The findings suggests that sleep interventions for adolescents may improve psychological well-being as an intermediate effect, as sleep improvements were observed mostly among participants with poor sleep quality or anxiety symptoms at baseline. This review identified several gaps in the literature. Despite documented racial and ethnic disparities in sleep quality among adolescents, published evidence of mind-body integrative health-based sleep interventions among Black and Latinx adolescents is lacking. None of the studies in this review assessed developmental stage or age differences, despite documented differences in sleep across age groups of adolescents. These two gaps in the evidence should be addressed in future intervention research.
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Affiliation(s)
- Samantha Garbers
- Columbia University Mailman School of Public Health, Heilbrunn Department of Population & Family Health, New York, NY
| | - Nawal Q. Umar
- Columbia University Mailman School of Public Health, New York, NY
| | - Rachel E. Hand
- Columbia University Mailman School of Public Health, New York, NY
| | - John Usseglio
- Augustus C. Long Health Sciences Library, Columbia University Irving Medical Center, New York, NY
| | - Melanie A. Gold
- Columbia University Mailman School of Public Health, Heilbrunn Department of Population & Family Health, New York, NY
- Columbia University Irving Medical Center, Department of Pediatrics, Division of Child and Adolescent Health, New York, NY
- New York-Presbyterian, School-Based Health Centers, New York, NY
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Passmore RC, Dunn M, Garbers S, Garth J, Gold MA. Needs Assessment of Integrative Health Services at School-Based Health Centers. Altern Ther Health Med 2022; 28:158-168. [PMID: 33245710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The purpose of this needs assessment was to hear about adolescents' experience with and interest in accessing integrative health services (IHS) at their school-based health centers (SBHCs) so that future education and service offerings could be better informed. SUBJECTS We surveyed 373 9th to 12th graders, of mostly low-income and minority status, who were enrolled as patients at 6 SBHCs in New York City, New York. Verbal consent was obtained prior to their completing a survey on provided mobile devices. DESIGN The 35-item anonymous survey asked about adolescents' health goals, familiarity and experience with 14 different integrative health modalities and interest in learning about and accessing these modalities. RESULTS Among all patients, the most common health goal was improving sleep (65%). Before completing the needs assessment survey, almost all patients (98%) had heard of at least 1 integrative health modality and 69% had ever used any modality. On average, patients were interested in learning more about 7.6 of the modalities and were significantly more interested in learning about each modality from trained professionals than from trained peers or by themselves. CONCLUSIONS Improving sleep was a central health goal for SBHC patients. The majority expressed interest in receiving information on massage, meditation and yoga from trained health professionals, and they wanted access to these modalities at their SBHCs. SBHCs are in a unique position of power in which they can bring desired, cost-effective integrative health modalities to marginalized students. Future efforts should expand provider training to support education on and delivery of these modalities and evaluation of their effectiveness at SBHCs.
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Diaz MF, Colleen G, Gruver R, Gold MA, Maier M, Usseglio J, Garbers S. Providing Contraceptive Health Services to Adolescents and Young Adults by Telemedicine: A Scoping Review of Patient and Provider Perspectives. J Pediatr Adolesc Gynecol 2022; 35:575-584. [PMID: 35644511 DOI: 10.1016/j.jpag.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/02/2022] [Accepted: 05/19/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The objective of this scoping review is to synthesize and identify gaps in existing research on accessibility of telemedicine-delivered contraceptive health services to female adolescents and young adults (AYAs) and acceptability of these services to AYA patients and their medical providers. METHODS We searched the PubMed, Scopus, Embase, and CINAHL databases to extract relevant studies on telemedicine and provision of contraceptive services among non-institutionalized, non-chronically ill female AYAs, ages 10 through 24 years. RESULTS We screened 154 articles, and 6 articles representing 5 studies met the full inclusion criteria. Three studies assessed telemedicine acceptability and accessibility from the perspective of providers, and 3 described patients' perceived accessibility and acceptability of a theoretical telemedicine visit. No studies directly assessed AYA patients' satisfaction with actual telemedicine visits for contraceptive services. Providers viewed telemedicine-delivered sexual and reproductive health (SRH) services as acceptable to themselves and AYA patients. Most AYAs reported that they would use telemedicine for SRH services, although they would prefer in-person care. All articles identified concerns about privacy and confidentiality as a barrier to SRH telemedicine care. CONCLUSIONS Telemedicine-delivered contraceptive health services for AYAs were perceived as acceptable and accessible by providers and by most AYA patients, although patients reported a preference for in-person care. However, none of these findings are based on patients' actual experiences with SRH telemedicine. Further research is needed to directly assess the accessibility and acceptability of telemedicine-delivered contraceptive health services for female AYA patients.
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Affiliation(s)
- Miranda F Diaz
- Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, New York
| | - Gunnar Colleen
- Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, New York
| | - Rachel Gruver
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York
| | - Melanie A Gold
- Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, New York; Columbia University Irving Medical Center, Department of Pediatrics, Division of Child and Adolescent Health, New York; NewYork-Presbyterian, School-Based Health Centers, New York
| | - Malia Maier
- Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, New York
| | - John Usseglio
- Columbia University Irving Medical Center, Augustus C. Long Health Sciences Library, New York
| | - Samantha Garbers
- Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, New York.
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Askew MA, Smaldone AM, Gold MA, Smith-Whitley K, Strouse JJ, Jin Z, Green NS. Pediatric hematology providers' contraceptive practices for female adolescents and young adults with sickle cell disease: A national survey. Pediatr Blood Cancer 2022; 69:e29877. [PMID: 35856776 PMCID: PMC9623811 DOI: 10.1002/pbc.29877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/25/2022] [Accepted: 06/15/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Adolescent and young adult (AYA) women with sickle cell disease (SCD) have increased pregnancy-related health risks and are prescribed potentially teratogenic medications, yet limited data are available regarding pediatric SCD provider contraceptive practices. We aimed to assess pediatric hematology providers' beliefs, practices, motivators, and barriers for providing contraceptive care to female AYAs with SCD. METHODS Guided by the Health Belief Model (HBM), we developed a 25-question, web-based survey to assess practices. Survey links were distributed nationwide to pediatric SCD and/or general hematology providers through their publicly available emails and by request to directors of U.S.-accredited Pediatric Hematology-Oncology fellowship programs for distribution to their SCD providers. Data analysis included descriptive statistics, chi-square analysis, and logistic regression. RESULTS Of 177 respondents, 160 surveys meeting inclusion criteria were analyzed. Most providers reported counseling (77.5%) and referring female AYA patients for contraception (90.8%), but fewer reported prescribing contraception (41.8%). Proportionally fewer trainees provided counseling compared with established providers (54% vs. 85%, p < .001), with a similar trend for prescribing (p = .05). Prescription practices did not differ significantly by provider beliefs regarding potential teratogenicity of hydroxyurea. Key motivators included patient request and disclosure of sexual activity. Key barriers included inadequate provider training, limited visit time, and perceived patient/parent interest. CONCLUSION Provider contraceptive practices for female AYAs with SCD varied, especially by provider status. Health beliefs regarding teratogenic potential of hydroxyurea did not correlate with contraceptive practices. Clinical guidelines, provider training, and patient/parent decision-making tools may be tested to assess whether provider contraceptive practices could be improved.
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Affiliation(s)
- Megan A Askew
- Department of Pediatrics, Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York, USA
| | - Arlene M Smaldone
- Department of Scholarship and Research, School of Nursing and College of Dental Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Melanie A Gold
- Department of Pediatrics, Division of Child and Adolescent Health, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York, USA
| | - Kim Smith-Whitley
- Division of Hematology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - John J Strouse
- Division of Hematology, Department of Medicine, Duke University, Durham, North Carolina, USA
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Zhezhen Jin
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Nancy S Green
- Department of Pediatrics, Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York, USA
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Loy MH, Usseglio J, Lasalandra D, Gold MA. Probiotic Use in Children and Adolescents with Overweight or Obesity: A Scoping Review. Child Obes 2022; 19:145-159. [PMID: 35723657 DOI: 10.1089/chi.2022.0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Context: Probiotics have been proposed as a prevention or treatment for pediatric overweight and obesity. Objective: Conduct a scoping review on probiotic use in children and adolescents with overweight or obesity and those with weight-related conditions and to identify knowledge gaps and research priorities. Data Sources: Seven databases using keywords and medical subject heading terms for articles reporting probiotic use in children or adolescents with overweight or obesity published from database conception until initiation of the study. Study Selection: Articles reporting primary data on probiotics use in children or adolescents with overweight or obesity. Data Extraction: We utilized the Arksey and O'Malley framework, PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines, followed a predetermined study protocol for level-one abstract and level-two full-text screenings, synthesized information into subject-area domains, and identified research gaps. Limitations: Heterogeneity of probiotic interventions, host factors, and genomics. Results: Database search yielded 1356 unique articles with 19 randomized placebo-controlled studies, 945 participants, duration of interventions from 8 weeks to 9 months. Disease indications included Nonalcoholic Fatty Liver Disease, insulin resistance, hypercholesterolemia, Prader-Willi Syndrome, metabolic syndrome, and obesity. Limited and heterogeneous evidence for probiotic use in children and adolescents with weight-related conditions noted. Heterogeneity among published articles in probiotic strains, doses, design, biomarkers, confirmation, and outcomes observed. Conclusions: Despite complex existing and limited data, studies to date of children and adolescents with overweight and obesity demonstrate potential beneficial treatment effects of probiotics on BMI, adiposity, metabolic parameters, inflammatory markers, fatty liver, transaminase levels, and glucose metabolism. Clinical trials to address heterogeneous results are needed.
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Affiliation(s)
- Michelle H Loy
- Department of Pediatrics, Weill Cornell Medicine, New York, New York, USA.,Department of Medicine, Weill Cornell Medicine, New York, New York, USA.,Integrative Health and Well-Being, Weill Cornell Medicine/New York Presbyterian Hospital, New York, New York, USA
| | - John Usseglio
- Health Sciences Library, Columbia University Irving Medical Center, New York, New York, USA
| | | | - Melanie A Gold
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, USA.,Section of Adolescent Medicine, Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA.,Center for Community Health and Education, School-Based Health Centers, NewYork Presbyterian, New York, New York, USA
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Borlack RE, Shan S, Zong AM, Khlevner J, Garbers S, Gold MA. Electrodermal Activity of Auricular Acupoints in Pediatric Patients With Functional Abdominal Pain Disorders. J Pediatr Gastroenterol Nutr 2021; 73:184-191. [PMID: 33853109 DOI: 10.1097/mpg.0000000000003137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Functional abdominal pain disorders (FAPD) affect approximately 13.5% of children. Pharmacotherapy is often ineffective, leaving providers, and families seeking adjunctive therapies. Auriculotherapy provides treatment for pain and other symptoms, without a defined protocol for FAPD. A handheld point-finder device measuring transdermal electrical current determines active acupoints, with a higher current indicating a more active acupoint. Our objectives were to determine auricular acupoint (AA) activity in FAPD and to assess participants' attitudes towards auriculotherapy. METHODS This is a prospective double-blind study evaluating the electrodermal activity of AAs in pediatric-aged female participants with FAPD compared to healthy controls (HC). Participants completed surveys regarding demographics and interest in auriculotherapy. The electrodermal assessment evaluated 20 AAs per ear using a point-finder device. Each AA current measurement was analyzed by average relative rank and median, with a median current measurement ≥50 μA considered active. RESULTS We enrolled 46 female participants, 22 FAPD (mean age 15.8 years) and 24 HC (mean age 15.4 years). In FAPD, 12 of 40 AAs were active, of which only six were also active in HC. Comparison of median current and average ranking between participants demonstrated consistency. In the post-assessment survey, 86.4% of FAPD expressed interest in receiving auricular acupressure and 68.2% would travel to the clinic solely for treatment. CONCLUSIONS Based on electrodermal measurements, we propose a treatment protocol using auriculotherapy for FAPD symptom-management. We demonstrated there is considerable patient interest in auriculotherapy. Further studies are needed to confirm the findings in a larger sample size and validate the efficacy of this treatment protocol.
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Affiliation(s)
- Rachel E Borlack
- Jacob School of Medicine and Biomedical Sciences, The State University of New York at Buffalo
- Division of Pediatric Gastroenterology and Nutrition, UBMD Pediatrics, Buffalo
| | | | | | - Julie Khlevner
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Columbia University Vagelos College of Physicians and Surgeons
| | - Samantha Garbers
- Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health
| | - Melanie A Gold
- Department of Pediatrics, Columbia University Irving Medical Center and Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, New York, NY
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Serafino S, Rajoria M, Gold MA, Garbers S. Evaluation of sexual orientation and gender identity documentation at school-based health centers in New York City. J Eval Clin Pract 2021; 27:1004-1008. [PMID: 33295105 DOI: 10.1111/jep.13522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/06/2020] [Accepted: 11/12/2020] [Indexed: 11/27/2022]
Abstract
RATIONALE National organizations have called for routine collection of data on sexual orientation and gender identity (SOGI) in clinical settings to track access to and quality of care provided to sexual and gender minority patients to improve health outcomes. However, there are limited data on this implementation for among adolescent populations. METHODS A secondary data analysis from seven school-based health centers (SBHCs) in New York City explored SOGI documentation for 8888 adolescent patients in 2015 to 2018. Using Electronic Health Records, SBHC medical providers' implementation rate of patient SOGI documentation was assessed. Trends in SOGI documentation were reviewed. RESULTS At 18-month post-EHR modification and training, SOGI documentation increased and was sustained at 47%. Those documented as female were significantly more likely to have SOGI documentation compared to those documented as male (36% vs 26% for SO; 36% vs 25% for GI). CONCLUSIONS This study identified incomplete data collection in SOGI documentation among adolescents receiving medical and mental health services in SBHCs.
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Affiliation(s)
- Stephanie Serafino
- HIV Center for Clinical and Behavioral Studies; Division of Gender, Sexuality, and Health, New York State Psychiatric Institute and Columbia University, New York, New York, USA.,Office of Population Health, HIV Services, NYC Health + Hospitals, New York, NY, USA
| | - Melinda Rajoria
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, USA.,College of Health and Human Performance, Department of Health Education and Behavior, University of Florida, Gainesville, FL, USA
| | - Melanie A Gold
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, USA.,Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
| | - Samantha Garbers
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, USA
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13
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Oviedo JD, Marquez E, Gold MA, Westhoff CL. Auricular acupressure and auricular acupuncture as an adjunct for pain management during first trimester aspiration abortion: A randomized, double-blinded, three-arm trial. Contraception 2021; 103:342-347. [PMID: 33607119 DOI: 10.1016/j.contraception.2021.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 02/04/2021] [Accepted: 02/10/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To measure pain and anxiety during first trimester uterine aspiration when using auricular acupressure or acupuncture as an adjunct to usual care. METHODS This randomized, double-blinded, three-arm trial enrolled patients undergoing an aspiration procedure for an induced abortion, a miscarriage, or other abnormal intrauterine pregnancy. Trial participants received auricular acupressure, auricular acupuncture, or placebo immediately prior to their procedures. The study began with 1:1:1 randomization, but later overenrolled into the acupressure group after providing retraining for greater fidelity to that intervention. All participants received ibuprofen and a paracervical block. Participants reported pain and anxiety levels via visual analog scores (0-100). Our analysis compared pain scores of those receiving acupressure versus placebo, and those receiving acupuncture versus placebo. RESULTS We randomized 177 participants over nine months and excluded data from four participants. We analyzed data from 70 participants who received acupressure, 51 who received acupuncture, and 52 who received placebo. The groups had similar baseline characteristics, including baseline pain and anxiety scores. For acupressure, acupuncture, and placebo groups, respectively, immediate post-procedure median pain scores were 50, 55, 47.5 (p = 0.88); maximum pain scores during the procedure were 77, 79, 79.5 (p = 0.96); postprocedure anxiety scores were 26, 28, and 21 (p = 0.47). The acupressure group results were similar before and after retraining. CONCLUSIONS Receiving auricular acupressure or acupuncture did not result in lower pain or anxiety scores among women undergoing vacuum aspiration compared to a placebo group. IMPLICATIONS The results of this trial were null, thus differing from our previous study that had shown a benefit from auricular acupuncture. Given the conflicting results, incorporating these acupuncture techniques into abortion practice would be premature.
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Affiliation(s)
- Johana D Oviedo
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center (CUIMC), NY, United States
| | - Emma Marquez
- Mailman School of Public Health, CUIMC, NY, United States
| | - Melanie A Gold
- Heilbrunn Department of Population & Family Health, Mailman School of Public Health, CUIMC, NY, United States; Department of Pediatrics, CUIMC, NY, United States
| | - Carolyn L Westhoff
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center (CUIMC), NY, United States; Mailman School of Public Health, CUIMC, NY, United States; Heilbrunn Department of Population & Family Health, Mailman School of Public Health, CUIMC, NY, United States.
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14
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Westhoff CL, Nelson IS, Suarez-Rodriguez A, Gold MA. Auricular acupressure and acupuncture as adjuncts for pain management during first trimester medication abortion: A randomized three-arm trial. Contraception 2020; 103:348-355. [PMID: 33340496 DOI: 10.1016/j.contraception.2020.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/03/2020] [Accepted: 12/06/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To measure pain during first trimester medication abortion using auricular acupressure or auricular acupuncture as an adjunct to pain management. We measured anxiety as a secondary outcome. STUDY DESIGN This randomized, double-blinded, 3-arm trial enrolled women seeking medication abortion with mifepristone and misoprostol. Participants received auricular acupressure, auricular acupuncture, or inert auricular placebo patches immediately after receiving mifepristone. In addition, all participants received ibuprofen to use at home as needed. The study started with 1:1:1 randomization, but later overenrolled into the acupressure group after retraining for greater fidelity to that intervention. Participants reported pain and anxiety using numeric rating scales via text message for 4 days, and using a visual analog scale at follow-up. Analyses compared median pain scores of those receiving acupressure, acupuncture, or placebo. RESULTS We randomized 136 participants of whom 57 received acupressure, 40 received acupuncture, and 39 received placebo. Groups had similar baseline characteristics. One hundred thirty-two participants (97%) reported outcomes by text message and 120 (88%) completed a follow-up interview. For acupressure, acupuncture and placebo groups the median maximum pain scores reported via text message were 60.0, 75.0, and 55.0 (p = 0.38); median maximum pain scores reported at follow-up were 76.5, 60.0, and 71.0 (p = 0.97), respectively. Acupressure results were similar before and after retraining. Maximum anxiety scores reported via text message were 10.0, 45.0, and 30.0 (p = 0.57). Maximum anxiety scores reported at follow-up were 10.5, 20.0, and 13.0 (p = 0.59). CONCLUSIONS Pain and anxiety during medication abortion were similar among women receiving acupressure, acupuncture or placebo. IMPLICATIONS We found no benefit in administering auricular acupressure or auricular acupuncture during medication abortion. These modalities are intended to be simple to use, but perhaps the brief provider training for this study was insufficient. These modalities should not be used in clinical practice without further study.
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Affiliation(s)
- Carolyn L Westhoff
- Department of Ob-Gyn, Columbia University Irving Medical Center (CUIMC), New York, NY, United States; Department of Epidemiology, Mailman School of Public Health, CUIMC, New York, NY, United States; Heilbrunn Department of Population and Family Health, Mailman School of Public Health, CUIMC, New York, NY, United States.
| | - Isabel S Nelson
- Department of Epidemiology, Mailman School of Public Health, CUIMC, New York, NY, United States
| | - Anderson Suarez-Rodriguez
- Department of Ob-Gyn, Columbia University Irving Medical Center (CUIMC), New York, NY, United States
| | - Melanie A Gold
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, CUIMC, New York, NY, United States; Department of Pediatrics, CUIMC, New York, NY, United States
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15
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Abstract
BACKGROUND Increasing access to non-pharmacologic pain management modalities, including acupuncture, has the potential to reduce opioid overuse. A lack of insurance coverage for acupuncture could present a barrier for both patients and providers. The objective of this scoping review was to assess the existing literature on acupuncture insurance coverage in the United States and to identify knowledge gaps and research priorities. METHODS We utilized the Arksey and O'Malley framework to guide our scoping review methodology. We followed a pre-determined study protocol for the level-one abstract and level-two full text screenings. We synthesized information into subject-area domains and identified knowledge gaps. RESULTS We found a lack of published data on acupuncture coverage in 44 states, especially in the Midwest and the South. Where data were available, a large proportion of acupuncture users did not have insurance coverage. Consumer demand, state mandates, and efforts to reduce opioid use were motivations to cover acupuncture. Licensed acupuncturists were less likely to be reimbursed and were reimbursed at lower rates compared to physicians. Reported barriers encountered when implementing coverage included a lack of providers, challenges determining when to offer non-pharmacologic treatments, and a lack of evidence for clinical efficacy and cost-effectiveness. CONCLUSION We found a lack of recent publications and data comparing regional coverage in the United States. A key challenge is that commercial insurance plan data are not in the public domain. Further research should assess insurance coverage implementation for acupuncture and measure the impact of policy changes on acupuncture utilization and rates of opioid overuse.
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Affiliation(s)
- Roselle Bleck
- Columbia University Mailman School of Public Health, New York, NY, USA.,David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Emma Marquez
- Columbia University Mailman School of Public Health, New York, NY, USA.,Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Melanie A Gold
- Columbia University Mailman School of Public Health, New York, NY, USA.,Department of Pediatrics, Columbia University Irving Medical Center, Now York, NY, USA
| | - Carolyn L Westhoff
- Columbia University Mailman School of Public Health, New York, NY, USA.,Department of Obstetrics & Gynecology, Columbia University Irving Medical Center, New York, NY, USA
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16
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Carney R, Vacca SH, Brown J, Gold MA. Translating Screening into Action: Risk Assessment and Intervention for Bullying in Pediatric Settings. J Pediatr Health Care 2020; 34:568-574. [PMID: 33097169 DOI: 10.1016/j.pedhc.2020.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 06/23/2020] [Accepted: 06/28/2020] [Indexed: 10/23/2022]
Abstract
The prevalence and consequences of childhood bullying demand routine screening and intervention in all pediatric health care settings. Although there are many validated screening tools available, there is little guidance on how to assess children at risk and provide interventions based on risk level. Guided by the Screening, Brief Intervention, and Referral to Treatment model for adolescent substance use, we reviewed the literature to identify factors that raise a child's risk level from bullying. In this article, we discuss the five factors identified and propose interventions for differential risk among children. Beyond screening questions and general guidance, a framework for identifying children most at risk of negative outcomes owing to bullying and practical next steps for care is essential. This article outlines such a framework for use by pediatric nurse practitioners and in pediatric care settings at large.
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17
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Fischer AM, Holmes P, Bahar YZ, Vacca S, Goldberg S, Gold MA. Aroma Acupoint Therapy for Symptom Management with Adolescent Patients: Early Experiences from School-Based Health Centers. Med Acupunct 2020; 32:287-292. [PMID: 33101573 DOI: 10.1089/acu.2020.1447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objectives: The American Academy of Pediatrics has long recognized a need for more resources for integrative medicine for health care providers and for patients. The aim of this study was to introduce Aroma Acupoint Therapy (AAT)-a relatively new integrative medicine modality using essential oils to activate acupoints-and to describe the early experiences of providers using AAT for adolescents at school-based health centers (SBHCs). Materials and Methods: This was a case series of 15 adolescents treated with 1 of 2 AAT specific protocols plus standard medical therapy between April 2018 and February 2019 at SBHCs. Of these 15 patients, ages 12-19, 14 were female. Clinical characteristics and treatment courses were abstracted by retrospective review of the patients' electronic medical records. The main outcomes and measures for this research were clinical characteristics, treatment courses and pre- and post-treatment pain scores for adolescents treated with AAT. Results: All 15 patients had nonspecific symptoms, including headaches, menstrual cramps, nausea, shortness of breath, chest pain, back pain, or dizziness. Pain scores were recorded in 8 of 15 encounters, and suggested improvements in most patients. Subjective documentation by the providers also suggested that most of these patients had reduced symptoms. Conclusions: With the call for nonopiate and integrative approaches to pain management, there is an urgent need to study the effectiveness of such modalities, such as AAT. It is safe, inexpensive, easy to learn, and is well-received by both health care providers and patients.
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Affiliation(s)
- Avital M Fischer
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA.,Department of Pediatrics, New York-Presbyterian, New York, NY, USA
| | | | - Yasmin Z Bahar
- Center for Community Health and Education, School Based Health Centers-New York, New York, NY, USA
| | - Susan Vacca
- Center for Community Health and Education, School Based Health Centers-New York, New York, NY, USA
| | - Sarah Goldberg
- Center for Community Health and Education, School Based Health Centers-New York, New York, NY, USA
| | - Melanie A Gold
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA.,Department of Pediatrics, New York-Presbyterian, New York, NY, USA.,Center for Community Health and Education, School Based Health Centers-New York, New York, NY, USA
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18
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Lalas J, Garbers S, Gold MA, Allegrante JP, Bell DL. Young Men's Communication With Partners and Contraception Use: A Systematic Review. J Adolesc Health 2020; 67:342-353. [PMID: 32624356 DOI: 10.1016/j.jadohealth.2020.04.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 04/17/2020] [Accepted: 04/22/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The rate of adolescent unintended pregnancy in the U.S. is high compared with that in other developed countries. While past research and interventions have focused on young women, the role of young men in pregnancy prevention has increasingly been recognized. Studies have assessed young men's knowledge and attitudes toward pregnancy prevention as well as their role in male-controlled methods of birth control such as condoms or withdrawal. However, less is known about how young men contribute to decision-making about contraceptive methods other than condoms with female partners. The purpose of this systematic review was to explore how young men communicate with their female partners and the effect of such communication on contraception use to prevent pregnancy. METHODS We conducted a systematic review of six databases to identify English language articles published from January 1, 2002, through March 24, 2019. The review specifically explored how young men aged 11-24 years communicate with and affect their female partner (noncondom) contraceptive use. The systematic review explored additional questions, including those pertaining to the timing of partner communication in a relationship, communication strategies used by young men, and which dynamics of partner communication were measured in studies. RESULTS Of the 12 articles identified as exploring male partner communication, five of the articles used quantitative analysis to measure any association between partner communication and contraception use, three of which produced statistically significant findings suggesting that communication increases the use of contraception other than condoms. Seven qualitative studies provided supporting narratives from young men describing communication with partners and how they influence contraception use by female partners. The articles also explored timing and strategies of communication, as well as topics, prompts, and communication cues used by young men. Measurements of both communication and contraception varied across studies. CONCLUSIONS With the small number of studies identified in this systematic review, we conclude that future research needs to corroborate the relationship between partner communication and contraception use with more robust and precise measurements of both communication and contraception.
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Affiliation(s)
- Jolene Lalas
- Department of Health and Behavior Studies, Teachers College, Columbia University, New York, New York.
| | - Samantha Garbers
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York
| | - Melanie A Gold
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York; Department of Pediatrics, Columbia University Irving Medical Center, New York, New York; New York-Presbyterian Hospital, New York, New York
| | - John P Allegrante
- Department of Health and Behavior Studies, Teachers College, Columbia University, New York, New York; Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York
| | - David L Bell
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York; Department of Pediatrics, Columbia University Irving Medical Center, New York, New York; New York-Presbyterian Hospital, New York, New York
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19
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Abstract
Introduction: The National Academy of Medicine recommends, and Joint Commission requires, offering non-pharmacologic approaches to pain management, including acupuncture, to reduce opioid overuse in the United States. This study describes 2019 state training requirements to evaluate how they represent opportunities and barriers to increasing access to acupuncture. Methods: We searched publicly available databases to identify Acupuncture Practice Acts and additional statutes and regulations pertaining to acupuncture training requirements on state licensure board websites. We then extracted state-specific acupuncture training requirements for individuals with and without a healthcare-related professional license. Results: Thirty-three states allow physicians to provide acupuncture without requiring any additional training requirements, 11 states and the District of Columbia (DC) require 200–300 training hours, and three require physicians to obtain a separate acupuncture license. Three states have no regulatory agency ruling. Forty states require non-healthcare professionals to complete an accredited program of more than 1900 h and pass an examination. Twenty-three states have an Acupuncture Detoxification Specialist designation allowing individuals without a clinical professional license to provide auricular acupuncture for substance use disorder treatment after a 70-h training course. Discussion: State-level training requirements are intended to increase safe and effective care, but variations represent a potential barrier to increasing the number of acupuncture providers in the United States. Allowing non-physician medical professionals to complete reduced training requirements for specific indications could be a model to increase access to acupuncture. The influence of training requirements on acupuncture access and opioid overuse needs examination.
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Affiliation(s)
- Roselle R Bleck
- Columbia University Mailman School of Public Health, New York, NY, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Melanie A Gold
- Columbia University Mailman School of Public Health, New York, NY, USA
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Carolyn L Westhoff
- Columbia University Mailman School of Public Health, New York, NY, USA
- Department of Obstetrics & Gynecology, Columbia University Irving Medical Center, New York, NY, USA
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20
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Giho Y, Jones KA, Dick RN, Gold MA, Talis JM, Gmelin TA, Laird HJ, Vanek MS, Miller E. Feasibility and acceptability of using a web-based contraceptive support tool in a university health clinic. J Am Coll Health 2020; 68:336-340. [PMID: 30908150 DOI: 10.1080/07448481.2019.1577859] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 11/07/2018] [Accepted: 01/29/2019] [Indexed: 06/09/2023]
Abstract
Objective: To evaluate feasibility of integrating Bedsider.org, a web-based contraceptive decision support tool, at a university health clinic (UHC). Participants: Female students (ages 18-29) seeking contraceptive care at the UHC were enrolled in September 2015 (n = 46). Methods: Providers recruited eligible patients during reproductive healthcare visits and introduced Bedsider. Surveys were administered immediately following the visit and a follow-up 2-4 weeks later. Electronic health records through 6 weeks post-enrollment were extracted. Results: Most patients had positive views toward Bedsider and appreciated receiving information during their UHC encounters. None were using long-acting reversible contraceptives (LARC) at enrollment. At follow-up, two patients self-reported IUD use. Among those recently sexually active, use of more effective contraceptive methods increased from 65% to 74%; 11% had initiated or were scheduled to receive a LARC. Conclusion: Bedsider can be feasibly integrated into UHC visits and may support women's selection of more effective contraceptive methods, including LARCs.
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Affiliation(s)
- Yukiko Giho
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- University of Pittsburgh Student Health Service, Pittsburgh, Pennsylvania, USA
| | - Kelley A Jones
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Rebecca N Dick
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Melanie A Gold
- Department of Pediatrics, Division of Child and Adolescent Health, Columbia University Medical Center, New York, New York, USA
- dDepartment of Population and Family Health, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Janine M Talis
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Theresa A Gmelin
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Hollis J Laird
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Marian S Vanek
- University of Pittsburgh Student Health Service, Pittsburgh, Pennsylvania, USA
| | - Elizabeth Miller
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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21
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Gondwe T, Ness R, Totten PA, Astete S, Tang G, Gold MA, Martin D, Haggerty CL. Novel bacterial vaginosis-associated organisms mediate the relationship between vaginal douching and pelvic inflammatory disease. Sex Transm Infect 2019; 96:439-444. [PMID: 31810995 PMCID: PMC7476288 DOI: 10.1136/sextrans-2019-054191] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 10/27/2019] [Accepted: 11/07/2019] [Indexed: 11/29/2022] Open
Abstract
Objectives We sought to determine whether the relationship between a history of vaginal douching and pelvic inflammatory disease (PID) is mediated by endometrial infection with one or more novel bacterial vaginosis (BV)-associated organisms among Atopobium vaginae, the BV-associated bacterium 1 (BVAB1), neathia (Leptotrichia) amnionii and Sneathia sanguinegens. Methods We first conducted log-binomial regression analyses to identify risk factors for endometrial infection in 535 adolescent and adult women with clinically suspected PID in the PID Evaluation and Clinical Health (PEACH) study. We then examined whether endometrial infection by the BV-associated organisms mediated the association between a history of vaginal douching and histologically confirmed PID using inverse probability weighted marginal structural models. Results Vaginal douching was significantly associated with endometrial infection with one or more of the targeted BV-associated organisms (relative risk (RR) 1.21, 95% CI: 1.08 to 1.35). The total effect estimate suggested that vaginal douching increased the risk of endometritis by 24% (RR 1.24, 95% CI: 1.03 to 1.49). The controlled direct effect of this association was attenuated with endometrial infection by one or more BV-associated organisms (adjusted RR (aRR) 1.00, 95% CI: 0.57 to 1.74) and endometrial infection by all four BV-associated organisms (aRR 0.95, 95% CI: 0.53 to 1.70) as intermediate variables. Conclusions Endometrial infection with one or more of the novel BV-associated organisms partially mediated the relationship between vaginal douching and histologically confirmed endometritis in the PEACH study. Frequent vaginal douching may confer risk for endometritis through increasing the risk of endometrial infection by novel-BV-associated organisms. Other potential pathways should be explored.
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Affiliation(s)
- Tamala Gondwe
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Roberta Ness
- Department of Epidemiology, Human Genetics & Environmental Sciences, The University of Texas School of Public Health, Houston, Texas, USA
| | - Patricia A Totten
- Department of Medicine, Division of Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Sabina Astete
- Department of Medicine, Division of Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Gong Tang
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Melanie A Gold
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center and Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - David Martin
- Department of Medicine, Louisiana State University, New Orleans, Louisiana, USA
| | - Catherine L Haggerty
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA .,Magee-Womens Research Institute, Pittsburgh, Pennsylvania, USA
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22
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Affiliation(s)
- Melanie A Gold
- Vagelos College of Physicians and Surgeons, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York.,Mailman School of Public Health, Heilbrunn Department of Population & Family Health, Columbia University Medical Center, New York, New York
| | - Susan L Rosenthal
- Vagelos College of Physicians and Surgeons, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York.,Vagelos College of Physicians and Surgeons, Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Milton L Wainberg
- Vagelos College of Physicians and Surgeons, Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
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23
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Ndubisi C, Danvers A, Gold MA, Morrow L, Westhoff CL. Auricular acupuncture as an adjunct for pain management during first trimester abortion: a randomized, double-blinded, three arm trial. Contraception 2019; 99:143-147. [DOI: 10.1016/j.contraception.2018.11.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 11/16/2018] [Accepted: 11/18/2018] [Indexed: 11/29/2022]
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24
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Timmons SE, Shakibnia EB, Gold MA, Garbers S. MyLARC: A Theory-Based Interactive Smartphone App to Support Adolescents' Use of Long-Acting Reversible Contraception. J Pediatr Adolesc Gynecol 2018; 31:285-290. [PMID: 29162531 DOI: 10.1016/j.jpag.2017.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 11/07/2017] [Accepted: 11/12/2017] [Indexed: 11/27/2022]
Abstract
STUDY OBJECTIVE Develop and test the feasibility of a Health Belief Model theory-based interactive smartphone application (app) aimed at providing information and support to adolescents with long-acting reversible contraception (LARC). DESIGN, SETTING, PARTICIPANTS, AND INTERVENTIONS Using a mixed-method design, we conducted 30 in-person interviews with adolescent LARC users who were enrolled in school-based health centers in New York City. Interviews were conducted in 2 phases: during phase 1, 12 participants viewed a pilot version of the app (MyLARC); during phase 2, 18 additional participants interacted with an expanded version of the app. Phase 2 participants downloaded MyLARC onto their smartphone and app usage was tracked. MAIN OUTCOME MEASURES Participants' responses to the in-person interviews and data usage of MyLARC from phase 2 determined the feasibility and acceptability of using MyLARC to support young women's satisfaction and continuation of LARC methods. RESULTS Noneducational games were recommended as an approach to provide information to adolescents in an engaging way, as well as educational graphics and visually appealing content. Data tracking of MyLARC usage among phase 2 participants revealed a total of 67 unique logins to the app with 18 average page visits per unique login. The total amount of times MyLARC was opened was 1197. The most frequented features were 'Info about LARC' (95 unique visits) and 'Games' (80 unique plays). CONCLUSION A theory-based interactive smartphone app with LARC-specific information and support is an appropriate and appealing medium to provide information and support to adolescents using LARC. Games represented a novel opportunity to engage adolescents with health information.
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Affiliation(s)
- Sarah E Timmons
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York.
| | - Emily Birchfield Shakibnia
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York
| | - Melanie A Gold
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York; Department of Pediatrics, Columbia University Medical Center and Population and Family Health, Mailman School of Public Health, School-Based Health Centers, New York-Presbyterian Hospital, Center for Community Health and Education, New York, New York
| | - Samantha Garbers
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York
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Garbers S, Hunersen K, Nechitilo M, Fisch M, Bell DL, Byrne MW, Gold MA. Healthy Weight and Cardiovascular Health Promotion Interventions for Adolescent and Young Adult Males of Color: A Systematic Review. Am J Mens Health 2018; 12:1328-1351. [PMID: 29808765 PMCID: PMC6142141 DOI: 10.1177/1557988318777923] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Cardiovascular disease is the leading cause of mortality in the United States, accounting for one fourth of deaths. Higher rates of obesity put Hispanic and Black men at increased risk. The American Heart Association cites diet quality, physical activity, and body weight as alterations responsive to health promotion intervention. Prevention strategies need to begin in adolescence and the emerging adulthood years to impact cumulative risk factors. A scoping review identified search terms and this was followed by a systematic review of Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PubMed databases for articles published in English from January 1, 2002, through May 11, 2017. This review explores community-based content, delivery, recruitment, or retention strategies used with young men of color aged 15 to 24 years. Of 17 articles describing 16 individual interventions and 1 describing multiple interventions (with samples ranging from 37 to 4,800), 13 reported significant results in one or more domains. No studies specifically targeted the needs of young men and only three had more than 50% male participants. There was a gap in studies that addressed young men in the ages of interest with most interventions reaching participants aged 11 to 19 years. Cultural tailoring was addressed through recruitment setting, interventionist characteristics, community involvement, and theoretical frameworks such as motivational interviewing that allow individual goal setting. Because young men seek access to preventive health services less than young women, it is suggested that interventions that are community based or use push technology (send information directly to the user) be increased.
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Affiliation(s)
- Samantha Garbers
- 1 Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Kara Hunersen
- 1 Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, New York, NY, USA
| | | | - Marylynn Fisch
- 2 Columbia University College of Physicians and Surgeons, New York, USA
| | - David L Bell
- 1 Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, New York, NY, USA.,2 Columbia University College of Physicians and Surgeons, New York, USA
| | | | - Melanie A Gold
- 1 Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, New York, NY, USA.,2 Columbia University College of Physicians and Surgeons, New York, USA
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Ramchandani K, Morrison P, Gold MA, Akers AY. Messages About Abstinence, Delaying Sexual Debut and Sexual Decision-Making in Conversations Between Mothers and Young Adolescents. J Pediatr Adolesc Gynecol 2018; 31:107-115. [PMID: 29097292 PMCID: PMC5866200 DOI: 10.1016/j.jpag.2017.10.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 10/11/2017] [Accepted: 10/23/2017] [Indexed: 11/30/2022]
Abstract
STUDY OBJECTIVE Little is known about the information shared during family discussions about sexuality. From a public health perspective, abstinence is one of the most important sexuality topics parents can talk about with adolescents. We sought to characterize the messages mothers communicate to young adolescents regarding abstinence. DESIGN Content analysis of dyadic discussions that occurred between June 2011-December 2012 between mothers and their 10- to 14-year-old adolescent sons and daughters. Discussions were audio-recorded, transcribed, and a grounded theory approach to content analysis performed. SETTING Urban city in Western Pennsylvania. PARTICIPANTS Twenty-one dyads; 15 mother-daughter dyads and 6 mother-son dyads. INTERVENTIONS None. MAIN OUTCOME MEASURES None. RESULTS Four key themes emerged reflecting the high priority mothers placed on abstinence, delaying their adolescent's sexual debut, and nurturing sexual decision-making skills. Theme 1 focused on ensuring that adolescents understand what abstinence means. In defining abstinence, only 1 mother explained what sex is. The 3 remaining themes emphasized sexual decision-making and emphasized when it is acceptable to stop being abstinent (theme 2), why abstinence is important (theme 3), and mothers' desire to engage in ongoing discussions, particularly when an adolescent was considering becoming sexually active (theme 4). Messages did not vary according to mothers' age or according to adolescent age, gender, or race. CONCLUSION Mothers convey complex information about abstinence and sexual decision-making to young, non-sexually active adolescents. Message tailoring on the basis of the adolescents' age or sex was not observed.
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Affiliation(s)
- Kanika Ramchandani
- PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Penelope Morrison
- Department of Health and Human Development, Penn State New Kensington, New Kensington, Pennsylvania
| | - Melanie A Gold
- Department of Pediatrics, Columbia University Medical Center, New York, New York; Department of Population and Family Health, Mailman School of Public Health, Columbia University Medical Center, New York, New York; School Based Health Centers, New York-Presbyterian Hospital, Center for Community Health and Education, New York, New York
| | - Aletha Y Akers
- PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Adolescent Gynecology Consultative Services, Departments of Obstetrics, Gynecology, and Pediatrics, Craig Dalsimer Division of Adolescent Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
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Affiliation(s)
- Shiu-Lin Tsai
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY
| | - Richard C. Niemtzow
- United States Air Force Acupuncture and Integrative Medicine Center, Joint Base Andrews, MD, and Editor-in-Chief of Medical Acupuncture.
| | - Melanie Brown
- Integrative Medicine Program, Children's Hospital and Clinics of Minnesota; and Pediatrics Department, University of Minnesota, Minneapolis, MN
| | - Melanie A. Gold
- Division of Child and Adolescent Health, Department of Pediatrics and Department of Population and Family Health at Columbia University Medical Center, School Based Health Centers, New York–Presbyterian Hospital, New York, NY
| | - Danielle M. Graff
- Pediatric Emergency Medicine, Pediatric Acupuncture, University of Louisville, Louisville, KY
| | - Im Quah-Smith
- Royal Women's Hospital, University of New South Wales, Randwick, New South Wales, Australia; Roseville Wellness Group, Roseville, New South Wales, Australia; and Centre for Healthy Brain Aging, University of New South Wales, Randwick, New South Wales, Australia
| | - Hilary McClafferty
- Fellowship in Integrative Medicine, Center for Integrative Medicine and Pediatric Integrative Medicine and Residency Program, University of Arizona College of Medicine, Tucson, AZ
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Shakibnia EB, Timmons SE, Gold MA, Garbers S. "It's Pretty Hard to Tell Your Mom and Dad That You're on a Method": Exploring How an App Could Promote Adolescents' Communication with Partners and Parent(s) to Increase Self-Efficacy in Long-Acting Reversible Contraception Use. J Pediatr Adolesc Gynecol 2018; 31:116-121. [PMID: 29024764 DOI: 10.1016/j.jpag.2017.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 08/30/2017] [Accepted: 09/26/2017] [Indexed: 10/18/2022]
Abstract
STUDY OBJECTIVE Youth-friendly information and support are integral components to promote adolescents' successful use of long-acting reversible contraception (LARC), and smartphone apps offer a promising medium. To inform content development for an app guided by the Health Belief Model, we conducted interviews with adolescent LARC users to assess self-efficacy and experiences with LARC, their communication with partners and parent(s) about LARC, and how apps could support this communication. DESIGN, SETTING, AND PARTICIPANTS We conducted semistructured, in-depth interviews with 30 female adolescent LARC users enrolled in urban school-based health centers. INTERVENTIONS AND MAIN OUTCOME MEASURES Descriptive analyses were used to assess demographic characteristics, experience and comfort communicating with current and future partners and parent(s) about LARC, self-efficacy around LARC, and how app elements could support LARC use. RESULTS Participants (mean age, 16 years; range, 14-19 years) were predominately Hispanic (77%; n = 23) and black (20%; n = 6). Almost all (97%; n = 29) had told their current partner about their LARC, but of these, only 15 (50%) would feel comfortable talking with a new sexual partner. Most participants (73%; n = 22) had not told their parent(s) about getting a LARC, but many reported they were likely to share app information with their parent(s). Of the few participants who did tell their parent(s), 38% (n = 3) reported that it was difficult to do so. Adolescents described ways in which app use could help initiate conversations with new partners and parent(s). CONCLUSION These findings suggest the potential of a theory-based smartphone app to meet adolescent LARC users' information and support needs. The app should include information on strategies for communicating with future partners and parent(s).
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Affiliation(s)
- Emily B Shakibnia
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York.
| | - Sarah E Timmons
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York
| | - Melanie A Gold
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York; Section of Adolescent Health, Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Medical Center, New York, New York; School-Based Health Centers, Center for Community Health and Education, New York-Presbyterian Hospital, New York, New York
| | - Samantha Garbers
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York
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Bell DL, Garbers S, Catallozzi M, Hum RS, Nechitilo M, McKeague IW, Koumans EH, House LD, Rosenthal SL, Gold MA. Computer-Assisted Motivational Interviewing Intervention to Facilitate Teen Pregnancy Prevention and Fitness Behavior Changes: A Randomized Trial for Young Men. J Adolesc Health 2018; 62:S72-S80. [PMID: 29455722 PMCID: PMC6518409 DOI: 10.1016/j.jadohealth.2017.06.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 06/21/2017] [Accepted: 06/22/2017] [Indexed: 11/19/2022]
Abstract
PURPOSE Despite recent declines, teen unintended pregnancy and sexually transmitted infections in the United States remain at levels higher than comparable nations. Initiatives to prevent teen pregnancy have focused primarily on female adolescents; how to effectively engage young men to reduce their risk of fathering a teen pregnancy has not been well studied. We proposed to adapt an innovative computer-assisted motivational interviewing (CAMI) intervention, originally designed and tested with young women, for use with young men, aged 15-24 years, to reduce their risk of fathering a teen pregnancy. This manuscript describes the design of a CAMI intervention for young men aimed at preventing teen pregnancy and improving fitness. METHODS This randomized controlled trial will recruit 945 sexually active young men between the ages of 15 and 24 years from three health centers in New York City. Participants will be assigned by permuted block randomization to two study arms: one aimed at reducing involvement in unintended teen pregnancy (CAMI-teen pregnancy prevention) and the other at improving overall fitness (CAMI-Fitness). Except for topic, both intervention arms will provide four sessions of Motivational Interviewing coaching and use a mobile app to track behavior and set goals. We will assess young men's sexual and reproductive health behaviors and fitness at baseline, 12, 24, 36, and 64 weeks using a mobile device app created for the study. RESULTS Pending ongoing study. CONCLUSIONS Results from the study are expected to enhance our understanding of the efficacy of CAMI to enhance young men's reproductive health and fitness behaviors.
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Affiliation(s)
- David L Bell
- Department of Pediatrics, Columbia University Medical Center, New York, New York; Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York; New York-Presbyterian Hospital, New York, New York.
| | - Samantha Garbers
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York
| | - Marina Catallozzi
- Department of Pediatrics, Columbia University Medical Center, New York, New York; Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York; New York-Presbyterian Hospital, New York, New York
| | - R Stanley Hum
- Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Meredith Nechitilo
- Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Ian W McKeague
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York
| | - Emilia H Koumans
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - L Duane House
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan L Rosenthal
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York; New York-Presbyterian Hospital, New York, New York; Department of Psychiatry, Columbia University Medical Center, New York, New York
| | - Melanie A Gold
- Department of Pediatrics, Columbia University Medical Center, New York, New York; Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York; New York-Presbyterian Hospital, New York, New York
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Garbers S, Heck CJ, Gold MA, Santelli JS, Bersamin M. Providing Culturally Competent Care for LGBTQ Youth in School-Based Health Centers: A Needs Assessment to Guide Quality of Care Improvements. J Sch Nurs 2017; 34:424-429. [DOI: 10.1177/1059840517727335] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
School-based health centers (SBHCs) can take specific steps to provide culturally competent care for lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth, potentially impacting well-being. A needs assessment survey was conducted among a convenience sample of SBHC administrators and medical directors to assess climates and actions supportive of LGBTQ quality medical care. Half (53%) of the SBHCs surveyed ( N = 66) reviewed print materials for negative LGBTQ stereotypes, and 27.3% conducted exhaustive materials review. Regional differences were detected: 46.2% of Southern SBHCs conducted any materials review compared to 91.3% in the West and all in the East and Midwest (χ2, p < .001). In the last academic year, 45.5% conducted no medical provider trainings, and 54.5% conducted no general staff trainings on providing care for LGBTQ youth. On intake forms, 85.4% included preferred names, but only 23.5% included preferred pronoun. There are significant gaps in the extent to which SBHCs provide culturally competent care. These findings can guide future training and advocacy.
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Affiliation(s)
- Samantha Garbers
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Craig J. Heck
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Melanie A. Gold
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY, USA
- Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- New York–Presbyterian Hospital, New York, NY, USA
| | - John S. Santelli
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY, USA
- Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Melina Bersamin
- Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, CA, USA
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Abstract
IMPORTANCE Adolescents have higher rates of unintended pregnancies than any other age group. Contraceptive implants and intrauterine devices (IUDs) are long-acting reversible contraceptives (LARCs) that are known to be highly effective in preventing pregnancy. New devices have recently been approved for use in adolescents, yet pediatricians may be less familiar with how to counsel adolescents about implants and IUDs. OBSERVATIONS LARC methods should be described in basic terms to adolescents, including hormone dose, method of insertion, and method of pregnancy prevention. Clinicians should appreciate the developmental stages of adolescents, discuss the most effective methods of contraception, and ensure confidentiality from their parents. Short-acting contraception methods (eg, oral contraceptives) can be used as a temporary bridge to provide coverage until a LARC method can be placed. The most common adverse effect of LARC is nuisance bleeding, which can be managed with short courses of oral contraceptives or nonsteroidal anti-inflammatory drugs. CONCLUSIONS AND RELEVANCE LARC devices constitute first-line contraceptive methods for adolescents. All clinicians, including pediatricians, can counsel about LARC even before suggesting an oral contraceptive or another less effective contraceptive method. Effective, confidential communication with sensitive language to inform adolescents of the different types of LARC is necessary to normalize offering LARC as a contraceptive option and improve its uptake among adolescents. Special clinical populations can also be offered appropriate contraceptive options inclusive of LARC.
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Affiliation(s)
- Jenny K R Francis
- Department of Pediatrics, Division of Child and Adolescent Health, Section of Adolescent Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, New York2New York-Presbyterian Hospital, Ambulatory Care Network, New York
| | - Melanie A Gold
- Department of Pediatrics, Division of Child and Adolescent Health, Section of Adolescent Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, New York3New York-Presbyterian Hospital, Ambulatory Care Network, Center for Community Health and Education, School-Based Health Centers, New York4Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University Medical Center, New York, New York
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Sangraula M, Garbers S, Garth J, Shakibnia EB, Timmons S, Gold MA. Integrating Long-Acting Reversible Contraception Services into New York City School-Based Health Centers: Quality Improvement to Ensure Provision of Youth-Friendly Services. J Pediatr Adolesc Gynecol 2017; 30:376-382. [PMID: 27871920 DOI: 10.1016/j.jpag.2016.11.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 11/04/2016] [Indexed: 11/18/2022]
Abstract
STUDY OBJECTIVE, DESIGN, AND SETTING Adolescents face barriers to accessing youth-friendly family planning services, specifically long-acting reversible contraception (LARC). School-based health centers (SBHCs) can provide youth-friendly care. A quality improvement project was undertaken to assess quality of care before, during, and after LARC services at 3 SBHCs, and to identify specific strategies for improving these LARC services. PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES We interviewed 18 female adolescents who received LARC services. Two independent reviewers coded deidentified verbatim transcripts; discrepancies were resolved by consensus with a third reviewer. A guide of themes was structured corresponding to Ambresin's domains of youth-friendly services. From these domains, we identified emerging themes using grounded theory, with a focus on practical suggestions for improving LARC services in SBHCs. RESULTS Interviewees ranged in age from 15 to 19 (average: 17) years. Most had insertions (12 levonorgestrel intrauterine system (LNG-IUS); Mirena®), 1 copper intrauterine device (Paragard®), 5 contraceptive implant (Nexplanon®). Overall, participants were highly satisfied with SBHC LARC services. Within the domain of communication, 2 key themes emerged: balancing need for information with concerns about being overwhelmed by information; and interest in information that directly addresses misconceptions about LARCs. Suggested strategies included providing postprocedure "care packages" with information and supplies, and supporting a peer-based network of adolescent LARC users and previous patients to serve as a resource for new patients. CONCLUSION This quality improvement project, conducted in a unique setting, gave adolescents a voice. The identified strategies for improving health education, social support, and outreach might be generalizable to other SBHCs. Future research could explore the effect of implementing these suggested strategies on reproductive health care use and outcomes at SBHCs.
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Affiliation(s)
- Manaswi Sangraula
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York.
| | - Samantha Garbers
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York
| | - Janet Garth
- Center for Community Health and Education, Family Planning and School-Based Health Center Programs, New York-Presbyterian Hospital, New York, New York
| | - Emily Birchfield Shakibnia
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York
| | - Sarah Timmons
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York
| | - Melanie A Gold
- Department of Pediatrics, Columbia University Medical Center and Population and Family Health, Mailman School of Public Health, School Based Health Centers, New York-Presbyterian Hospital, Center for Community Health and Education, New York, New York
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Garbers S, Scheinmann R, Gold MA, Catallozzi M, House L, Koumans EH, Bell DL. Males' Ability to Report Their Partner's Contraceptive Use at Last Sex in a Nationally Representative Sample: Implications for Unintended Pregnancy Prevention Evaluations. Am J Mens Health 2017; 11:711-718. [PMID: 27923969 PMCID: PMC5675240 DOI: 10.1177/1557988316681667] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 10/31/2016] [Accepted: 11/03/2016] [Indexed: 11/16/2022] Open
Abstract
Addressing and enabling the role of males in contraceptive choices may facilitate efforts to reduce unintended pregnancy rates and disparities in the United States, but little is known about males' ability to report their partners' contraceptive use. Data from the 2011-2013 National Survey of Family Growth from 2,238 males aged 15 to 44 years who had vaginal sex with a noncohabiting or nonmarital partner and were not seeking pregnancy were examined to tabulate the proportion of males able to report whether their partner used a specific contraceptive method use at last sex (PCM) by sociodemographic and sexual history characteristics. Logistic regression was used to assess odds of being unable to report PCM, adjusting for age and sexual history factors. Most (95.0%) were able to report PCM, with no difference by age group (chi-square = 7.27, p = .281) in unadjusted analyses. Males with a new sex partner (14.8% of the sample), compared with those with an established sex partner, had significantly higher odds of being unable to report PCM in bivariate (11.7% vs. 3.7%, chi-square = 39.39, p < .001) and multivariable (adjusted odds ratio [AOR]: 3.17, 95% confidence interval [CI: 1.74, 5.65]) analyses. Those whose last sexual encounter was more than 3 months ago also had higher odds of being unable to report in bivariate ( OR: 1.74, 95% CI [1.05, 2.87]) and multivariable analyses (AOR: 2.04, 95% CI [1.04, 4.03]). Most men were able report PCM, but reporting was significantly lower among men with new sex partners. To inform future research and evaluation relying on male report, validation studies comparing male report with partner report, specifically among new couples, are needed.
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Affiliation(s)
| | | | - Melanie A. Gold
- Columbia University, New York, NY, USA
- New York-Presbyterian Hospital, New York, NY, USA
| | - Marina Catallozzi
- Columbia University, New York, NY, USA
- New York-Presbyterian Hospital, New York, NY, USA
| | - Lawrence House
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Abstract
To optimally address sex and sexuality, normalize gender and sexual diversities, and attend to adolescents' needs, clinicians will best serve their patients and their families by becoming comfortable initiating confidential, developmentally appropriate discussions with all adolescent patients. The goal is to create a safe, affirming, nonjudgmental space wherein adolescents may learn about sexual matters, discuss concerns, ask questions, and find support to assist them to achieve healthy, positive development. This article provides useful, practical suggestions to begin these conversations, offers specific examples and tips to encourage dialogue, and discusses ways to be a resource to adolescent patients.
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Affiliation(s)
- Betsy Pfeffer
- Division of Child & Adolescent Health, Columbia University Medical Center, Columbia University College of Physicians and Surgeons, 622 West 168th Street, VC4-417, New York, NY 10032, USA.
| | - Taylor Rose Ellsworth
- Division of Education, Research and Training, Physicians for Reproductive Health, 55 West 39th Street, Suite 1001, New York, NY 10018, USA
| | - Melanie A Gold
- Department of Pediatrics, Center for Community and Health Education, Columbia University Medical Center, New York, NY 10032, USA; Department of Population and Family Health, Center for Community and Health Education, Columbia University Medical Center, 60 Haven Avenue, Level B-3, Room 308, New York, NY 10032, USA
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Abstract
There has been extensive research on the use of acupuncture in adults with a wide array of conditions. Much less research has been conducted on the use of acupuncture in children. In this article, we review the history and philosophy of acupuncture, and the literature on its effectiveness and safety in children and adolescents, giving special attention to the pediatric and adolescent conditions that have been most studied in high-quality randomized controlled trials (RCTs).
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Affiliation(s)
- Mindy Brittner
- Department of Pediatrics, Columbia University Medical Center, New York, NY; Department of Population and Family Health, Columbia University Medical Center, New York, NY
| | - Noemie Le Pertel
- Department of Pediatrics, Columbia University Medical Center, New York, NY; Department of Population and Family Health, Columbia University Medical Center, New York, NY
| | - Melanie A Gold
- Department of Pediatrics, Columbia University Medical Center, New York, NY; Department of Population and Family Health, Columbia University Medical Center, New York, NY
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Shah B, Chan SH, Perriera L, Gold MA, Akers AY. Teaching Trainees to Deliver Adolescent Reproductive Health Services. J Pediatr Adolesc Gynecol 2016; 29:53-61. [PMID: 26542014 PMCID: PMC4681699 DOI: 10.1016/j.jpag.2015.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 05/11/2015] [Accepted: 06/05/2015] [Indexed: 11/20/2022]
Abstract
STUDY OBJECTIVE Delivery of reproductive services to adolescents varies according to specialty and has been linked to differences in clinical training. Few studies have explored how different specialties' graduate medical education (GME) programs prepare providers to deliver adolescent reproductive services. We explored the perceptions of resident physicians regarding their training in delivering adolescent reproductive health services. DESIGN Between November 2008 and February 2009, 9 focus groups were conducted with graduate medical trainees in 3 specialties that routinely care for adolescents. The semistructured discussions were audio-recorded, transcribed, and analyzed using an inductive approach to content analysis. SETTING Large, urban academic medical center in Pittsburgh, Pennsylvania. PARTICIPANTS Fifty-four resident trainees in pediatrics, family medicine, and obstetrics/gynecology. INTERVENTIONS None. MAIN OUTCOME MEASURES Trainees' perspectives regarding the didactic teaching and clinical training in providing adolescent reproductive services. RESULTS Five themes emerged, reflecting trainees' beliefs regarding the best practices in which GME programs can engage to ensure that trainees graduate with the belief that they are competent and will be comfortable delivering adolescent reproductive services. Trainees believed programs need to: (1) provide didactic lectures and diverse inpatient and outpatient clinical experiences; (2) have faculty preceptors skilled in providing and supervising adolescent reproductive services; (3) teach skills for engaging adolescents in clinical assessments and decision-making; (4) train providers to navigate confidentiality issues with adolescents and caregivers; and (5) provide infrastructure and resources for delivering adolescent reproductive services. CONCLUSION The 3 specialties differed in how well each of the 5 best practices were reportedly addressed during GME training. Policy recommendations are provided.
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Affiliation(s)
- Brandi Shah
- Division of Adolescent Medicine, Department of Pediatrics, University of Washington/Seattle Children's Hospital, Seattle, Washington
| | - Serena H Chan
- Division of Pediatric and Adolescent Gynecology, Cincinnati Children's Hospital Medical Center, Cincinatti, Ohio
| | - Lisa Perriera
- Department of Obstetrics and Gynecology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Melanie A Gold
- Center for Community Health and Education, New York, New York
| | - Aletha Y Akers
- Department of Pediatrics, Obstetrics and Gynecology, The Craig Dalsimer Division of Adolescent Medicine, Philadelphia, Pennsylvania.
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Gold MA, Tzilos GK, Stein LAR, Anderson BJ, Stein MD, Ryan CM, Zuckoff A, DiClemente C. A Randomized Controlled Trial to Compare Computer-assisted Motivational Intervention with Didactic Educational Counseling to Reduce Unprotected Sex in Female Adolescents. J Pediatr Adolesc Gynecol 2016; 29:26-32. [PMID: 26514957 PMCID: PMC4670811 DOI: 10.1016/j.jpag.2015.06.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 05/06/2015] [Accepted: 06/01/2015] [Indexed: 10/23/2022]
Abstract
STUDY OBJECTIVE To examine a computer-assisted, counselor-guided motivational intervention (CAMI) aimed at reducing the risk of unprotected sexual intercourse. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: We conducted a 9-month, longitudinal randomized controlled trial with a multisite recruitment strategy including clinic, university, and social referrals, and compared the CAMI with didactic educational counseling in 572 female adolescents with a mean age of 17 years (SD = 2.2 years; range = 13-21 years; 59% African American) who were at risk for pregnancy and sexually transmitted diseases. The primary outcome was the acceptability of the CAMI according to self-reported rating scales. The secondary outcome was the reduction of pregnancy and sexually transmitted disease risk using a 9-month, self-report timeline follow-back calendar of unprotected sex. RESULTS The CAMI was rated easy to use. Compared with the didactic educational counseling, there was a significant effect of the intervention which suggested that the CAMI helped reduce unprotected sex among participants who completed the study. However, because of the high attrition rate, the intent to treat analysis did not demonstrate a significant effect of the CAMI on reducing the rate of unprotected sex. CONCLUSION Among those who completed the intervention, the CAMI reduced unprotected sex among an at-risk, predominantly minority sample of female adolescents. Modification of the CAMI to address methodological issues that contributed to a high drop-out rate are needed to make the intervention more acceptable and feasible for use among sexually active predominantly minority, at-risk, female adolescents.
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Affiliation(s)
- MA Gold
- Columbia University Medical Center, Department of Pediatrics, Division of Child and Adolescent Health, Mailman School of Public Health, Department of Population and Family Health, and New York-Presbyterian Hospital, New York, NY
| | - GK Tzilos
- Brown University, Department of Psychiatry & Human Behavior, Providence, RI
| | - LAR Stein
- University of Rhode Island, Department of Psychology, Kingston, RI
| | | | - MD Stein
- Brown University, Department of Medicine, Public Health & Public Policy, Providence, RI
| | - CM Ryan
- University of Pittsburgh, Department of Psychiatry, Psychology, Health and Community Systems, Pittsburgh, PA
| | - A Zuckoff
- University of Pittsburgh, Departments of Psychology and Psychiatry, Pittsburgh, PA
| | - C DiClemente
- University of Maryland, Department of Psychology, Maryland, MD
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Bersamin M, Garbers S, Gold MA, Heitel J, Martin K, Fisher DA, Santelli J. Measuring Success: Evaluation Designs and Approaches to Assessing the Impact of School-Based Health Centers. J Adolesc Health 2016; 58:3-10. [PMID: 26707224 PMCID: PMC4693147 DOI: 10.1016/j.jadohealth.2015.09.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 09/08/2015] [Accepted: 09/08/2015] [Indexed: 10/22/2022]
Abstract
Since the founding of the first school-based health centers (SBHCs) >45 years ago, researchers have attempted to measure their impact on child and adolescent physical and mental health and academic outcomes. A review of the literature finds that SBHC evaluation studies have been diverse, encompassing different outcomes and varying target populations, study periods, methodological designs, and scales. A complex picture emerges of the impact of SBHCs on health outcomes, which may be a function of the specific health outcomes examined, the health needs of specific communities and schools, the characteristics of the individuals assessed, and/or the specific constellation of SBHC services. SBHC evaluations face numerous challenges that affect the interpretation of evaluation findings, including maturation, self-selection, low statistical power, and displacement effects. Using novel approaches such as implementing a multipronged approach to maximize participation, entering-class proxy-baseline design, propensity score methods, data set linkage, and multisite collaboration may mitigate documented challenges in SBHC evaluation.
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Affiliation(s)
- Melina Bersamin
- Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, California.
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Gold MA. Improving Osteopathic Medical Training in Providing Health Care to Lesbian, Gay, Bisexual, and Transgender Patients. J Osteopath Med 2014; 114:750-1. [DOI: 10.7556/jaoa.2014.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Russo JA, Miller E, Gold MA. Myths and misconceptions about long-acting reversible contraception (LARC). J Adolesc Health 2013; 52:S14-21. [PMID: 23535052 DOI: 10.1016/j.jadohealth.2013.02.003] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 02/03/2013] [Accepted: 02/04/2013] [Indexed: 01/09/2023]
Abstract
PURPOSE To discuss common myths and misconceptions about long-acting reversible contraception (LARC) among patients and health care providers. METHODS We address some of these common myths in an effort to provide clinicians with accurate information to discuss options with patients, parents, and referring providers. The list of myths was created through an informal survey of an online listserv of 200 family planning experts and from the experiences of the authors. RESULTS When presented with information about LARC, adolescents are more likely to request LARC and are satisfied with LARC. Clinicians have an important role in counseling about and providing LARC to their adolescent patients as well as supporting them in managing associated side effects. CONCLUSIONS This review article can be used as a resource for contraceptive counseling visits and for the continuing education of health professionals providing adolescent reproductive health care.
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Affiliation(s)
- Jennefer A Russo
- Planned Parenthood of Orange and San Bernardino Counties, Orange, California 92866, USA.
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Schilder RJ, Sill MW, Lankes HA, Gold MA, Mannel RS, Modesitt SC, Hanjani P, Bonebrake AJ, Sood AK, Godwin AK, Hu W, Alpaugh RK. A phase II evaluation of motesanib (AMG 706) in the treatment of persistent or recurrent ovarian, fallopian tube and primary peritoneal carcinomas: a Gynecologic Oncology Group study. Gynecol Oncol 2013; 129:86-91. [PMID: 23321064 PMCID: PMC3712785 DOI: 10.1016/j.ygyno.2013.01.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 01/02/2013] [Accepted: 01/08/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Vascular endothelial growth factors (VEGF) and their receptors have a critical role in stimulating the growth of ovarian cancer cells. Motesanib is a small molecule inhibitor of multiple receptor tyrosine kinases including VEGF receptors 1-3, as well as c-KIT and platelet-derived growth factor which are related to the VEGF family. PATIENTS AND METHODS Twenty-two eligible patients with recurrent ovarian, fallopian tube or primary peritoneal carcinoma were treated with an oral daily dose of 125 mg of motesanib. Peripheral blood was analyzed for circulating tumor cells (CTC) and circulating endothelial cells/circulating endothelial progenitors (CEC/CEP), VEGF levels and cell-free circulating DNA (cfDNA). RESULTS The study was abruptly halted after four patients developed posterior reversible encephalopathy syndrome. One patient had a partial response and seven patients had stable disease at the time they were removed from study treatment. Twelve of the 22 patients (50%) had indeterminate responses at trial closure. Early closure without clinical efficacy data precludes meaningful correlative studies. CONCLUSIONS The serious central nervous system toxicity observed in patients with recurrent ovarian cancer precluded full examination of this agent in this population. There were no clear cut explanations for the high incidence of this known class effect in the study population compared with patients with other cancers.
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Affiliation(s)
- R J Schilder
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
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Affiliation(s)
- Andrew J Barnes
- Developmental-Behavioral Pediatrics, University of Minnesota, Minneapolis, MN, USA
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Clarke J, Gold MA, Simon RE, Roberts MB, Stein LAR. Motivational interviewing with computer assistance as an intervention to empower women to make contraceptive choices while incarcerated: study protocol for randomized controlled trial. Trials 2012; 13:101. [PMID: 22747705 PMCID: PMC3487955 DOI: 10.1186/1745-6215-13-101] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Accepted: 06/11/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Unplanned pregnancies and sexually transmitted infections (STIs) are important and costly public health problems in the United States resulting from unprotected sexual intercourse. Risk factors for unplanned pregnancies and STIs (poverty, low educational attainment, homelessness, substance abuse, lack of health insurance, history of an abusive environment, and practice of commercial sex work) are especially high among women with a history of incarceration. Project CARE (Contraceptive Awareness and Reproductive Education) is designed to evaluate an innovative intervention, motivational interviewing with computer assistance (MICA), aimed at enhancing contraceptive initiation and maintenance among incarcerated women who do not want a pregnancy within the next year and who are anticipated to be released back to the community. This study aims to: (1) increase the initiation of highly effective contraceptives while incarcerated; (2) increase the continuation of highly effective contraceptive use at 3, 6, 9, and 12 months after release; and (3) decrease unsafe sexual activity. METHODS/DESIGN This randomized controlled trial will recruit 400 women from the Rhode Island Department of Corrections (RI DOC) women's jail at risk for an unplanned pregnancy (that is, sexually active with men and not planning/wanting to become pregnant in the next year). They will be randomized to two interventions: a control group who receive two educational videos (on contraception, STIs, and pre-conception counseling) or a treatment group who receive two sessions of personalized MICA. MICA is based on the principles of the Transtheoretical Model (TTM) and on Motivational Interviewing (MI), an empirically supported counseling technique designed to enhance readiness to change targeted behaviors. Women will be followed at 3, 6, 9, and 12 months post release and assessed for STIs, pregnancy, and reported condom use. DISCUSSION Results from this study are expected to enhance our understanding of the efficacy of MICA to enhance contraceptive initiation and maintenance and reduce sexual risk-taking behaviors among incarcerated women who have re-entered the community. TRIAL REGISTRATION NCT01132950.
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Affiliation(s)
- Jennifer Clarke
- Brown University Center for Primary Care and Prevention, Pawtucket, RI, USA
- Memorial Hospital of Rhode Island, Pawtucket, RI, USA
| | - Melanie A Gold
- Department of Pediatrics, Division of Adolescent Medicine, University of Pittsburgh School of Medicine, Staff Physician, Division of Student Affairs, Pittsburgh, PA, USA
| | - Rachel E Simon
- Brown University Center for Primary Care and Prevention, Pawtucket, RI, USA
- Memorial Hospital of Rhode Island, Pawtucket, RI, USA
| | - Mary B Roberts
- Brown University Center for Primary Care and Prevention, Pawtucket, RI, USA
- Memorial Hospital of Rhode Island, Pawtucket, RI, USA
| | - LAR Stein
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
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De Genna NM, Feske U, Larkby C, Angiolieri T, Gold MA. Pregnancies, abortions, and births among women with and without borderline personality disorder. Womens Health Issues 2012; 22:e371-7. [PMID: 22749198 PMCID: PMC3397795 DOI: 10.1016/j.whi.2012.05.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 04/27/2012] [Accepted: 05/06/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND The purpose of this study was to examine history of pregnancies among women with and without borderline personality disorder (BPD), to determine whether BPD symptoms are associated with teenage pregnancies, unplanned pregnancies, elective and spontaneous abortions, and live births. METHODS Three hundred seventy-nine women completed the Structured Clinical Interview for DSM-IV Axis I diagnoses, Structured Interview for DSM-IV Personality for Axis II diagnoses, and a reproductive health interview. African-American (AA) women were oversampled, because little is known about BPD in AA women and they are at greater risk of teenage pregnancy, unplanned pregnancies, and spontaneous abortions. RESULTS BPD symptom severity was associated with a teenage pregnancy, even after controlling for race and socioeconomic status. Symptom severity was also associated with unplanned pregnancies and live births, but only for women without a history of a substance use disorder. BPD symptom severity was not associated with abortion. CONCLUSION Women with BPD become pregnant and have children, often during the period when BPD symptoms emerge and intensify. They are at increased risk of teenage pregnancies and unintended pregnancies compared with women with Axis I disorders. Treatment planning for this population should include attention to their reproductive health and better integration of physical and mental health services.
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Affiliation(s)
- Natacha M. De Genna
- NM De Genna is the Corresponding Author. Department of Psychiatry, University of Pittsburgh Medical School, Program in Epidemiology, Webster Hall - Suite 108, 4415 Fifth Avenue, Pittsburgh, PA, 15213. . Phone: (412) 246-6213 Fax: 412-246-6875
| | - Ulrike Feske
- School of Pharmacy, University of Pittsburgh, 3520 Forbes Avenue, Suite 203, Pittsburgh, PA, 15213. , Phone: (412) 383-2334 Fax: (412) 624-2489
| | - Cynthia Larkby
- NM De Genna is the Corresponding Author. Department of Psychiatry, University of Pittsburgh Medical School, Program in Epidemiology, Webster Hall - Suite 108, 4415 Fifth Avenue, Pittsburgh, PA, 15213. . Phone: (412) 246-6213 Fax: 412-246-6875
| | - Teresa Angiolieri
- School of Pharmacy, University of Pittsburgh, 3520 Forbes Avenue, Suite 203, Pittsburgh, PA, 15213. , Phone: (412) 383-2334 Fax: (412) 624-2489
| | - Melanie A. Gold
- Division of Adolescent Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Medical Arts Building - Suite 500, 3708 Fifth Avenue, Pittsburgh, PA, 15213. Phone: (412) 383-1800 Fax: (412) 383-1807
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Akers AY, Gold MA, Coyne-Beasley T, Corbie-Smith G. A qualitative study of rural black adolescents' perspectives on primary STD prevention strategies. Perspect Sex Reprod Health 2012; 44:92-99. [PMID: 22681424 PMCID: PMC4326105 DOI: 10.1363/4409212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
CONTEXT Primary STD prevention relies on five key strategies: practicing abstinence, choosing low-risk partners, discussing partners' sexual history, using condoms consistently and not having multiple partners. Few studies have examined all of these strategies simultaneously, and few have focused on rural black adolescents, whose rates of early sexual initiation and STDs are among the highest in the nation. METHODS In 2006, a sample of 37 black adolescents (20 female, 17 male) from two rural North Carolina counties participated in focus groups that explored their understanding of how primary prevention strategies reduce STD transmission, the common barriers they encounter in trying to adopt these strategies and the risk reduction strategies that they employ. Transcripts were analyzed using a grounded theory approach. RESULTS Adolescents understood how primary prevention strategies reduce STD transmission. However, they perceived sex as normal and abstinence as unlikely during adolescence. Furthermore, they considered the remaining primary prevention strategies difficult to implement because these strategies depend on partner cooperation and incorrectly assume that STD prevention is paramount when adolescents make sexual decisions. Adolescents reported using alternative strategies to reduce their STD risk; the most commonly used approaches were indirect assessments of partner characteristics (e.g., evaluating partners' physical appearance and sexual history) and STD testing (to identify and treat infections). CONCLUSION Adolescents try to reduce their STD risk, but do so by using ineffective practices. Promoting primary prevention strategies requires helping adolescents to identify opportunities to successfully employ these strategies.
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Affiliation(s)
- Aletha Y Akers
- Department of Obstetrics, Gynecology and Reproductive Sciences, the University of Pittsburgh, USA.
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Cardoza VJ, Documét PI, Fryer CS, Gold MA, Butler J. Sexual health behavior interventions for U.S. Latino adolescents: a systematic review of the literature. J Pediatr Adolesc Gynecol 2012; 25:136-149. [PMID: 22206687 PMCID: PMC3437918 DOI: 10.1016/j.jpag.2011.09.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Accepted: 09/27/2011] [Indexed: 10/14/2022]
Abstract
STUDY OBJECTIVE To identify sexual health behavior interventions targeting U.S. Latino adolescents. DESIGN A systematic literature review. SETTING Peer-reviewed articles published between 1993 and 2011, conducted in any type of setting. PARTICIPANTS Male and female Latino adolescents ages 11-21 years. INTERVENTIONS Interventions promoting sexual abstinence, pregnancy prevention, sexually transmitted infection (STI) prevention, and/or HIV/AIDS prevention. MAIN OUTCOME MEASURES Changes in knowledge, attitudes, engagement in risky sexual behaviors, rates of STIs, and/or pregnancy. RESULTS Sixty-eight articles were identified. Fifteen were included in this review that specifically addressed Latino adolescent sexual health behavior. Among the reviewed interventions, most aimed to prevent or reduce STI and HIV/AIDS incidence by focusing on behavior change at two levels of the social ecological model: individual and interpersonal. Major strengths of the articles included addressing the most critical issues of sexual health; using social ecological approaches; employing different strategies to deliver sexual health messages; and employing different intervention designs in diverse geographical locations with the largest population of Latino communities. Most of the interventions targeted female adolescents, stressing the need for additional interventions that target Latino adolescent males. CONCLUSIONS Latino adolescent sexual health is a new research field with gaps that need to be addressed in reducing negative sexual health outcomes among this population. More research is needed to produce new or validate existing, age-specific, and culturally-sensitive sexual health interventions for Latino male and female adolescents. Further, this research should also be conducted in areas of the U.S. with the newest Latino migration (e.g., North Carolina).
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Affiliation(s)
- Vicky J Cardoza
- National Council of La Raza, Institute for Hispanic Health, Washington, District of Columbia, USA.
| | - Patricia I Documét
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Craig S Fryer
- Department of Behavioral and Community Health, Maryland Center for Health Equity, School of Public Health, University of Maryland, College Park, Maryland, USA
| | - Melanie A Gold
- Department of Pediatrics, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania, USA
| | - James Butler
- Department of Behavioral and Community Health, Maryland Center for Health Equity, School of Public Health, University of Maryland, College Park, Maryland, USA
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Rubin AG, Gold MA, Kim Y, Schwarz EB. Use of emergency contraception by US teens: effect of access on promptness of use and satisfaction. J Pediatr Adolesc Gynecol 2011; 24:286-90. [PMID: 21600808 DOI: 10.1016/j.jpag.2011.03.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Revised: 03/25/2011] [Accepted: 03/29/2011] [Indexed: 10/18/2022]
Abstract
STUDY OBJECTIVE To examine the effect of policies regarding access to emergency contraception (EC) on teens' promptness of EC use and satisfaction with EC access experience. SETTING Online survey. PARTICIPANTS Females, ages 14 to 19, who had engaged in unprotected intercourse at a time when they were aware of EC. MAIN OUTCOME MEASURES Outcomes included promptness of EC use and satisfaction with EC access experience. Outcomes were compared according to method of obtaining EC and state policies regarding EC access. RESULTS Surveys were completed by 531 teens from 49 states; 58% were Caucasian and 14% were African American. Only 48% of participants reported ever using EC. Teens who obtained EC without a prescription were more likely to use EC within 24 hours of unprotected intercourse (odds ratio = 2.17; 95% confidence interval: 1.06-4.44). Minors who obtained EC in pharmacist-access states were more likely to be satisfied with their EC access experience (odds ratio = 3.05; 95% confidence interval: 1.11-8.35). CONCLUSION Fewer than half of participants had used EC, despite being aware of EC at the time of unprotected intercourse. Policies allowing minors to access EC without a prescription may increase timely use of EC.
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Affiliation(s)
- Alison G Rubin
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
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Sucato GS, Land SR, Murray PJ, Cecchini R, Gold MA. Adolescents' experiences using the contraceptive patch versus pills. J Pediatr Adolesc Gynecol 2011; 24:197-203. [PMID: 21454110 DOI: 10.1016/j.jpag.2011.02.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Revised: 01/30/2011] [Accepted: 02/01/2011] [Indexed: 11/24/2022]
Abstract
STUDY OBJECTIVE To compare use of the weekly transdermal contraceptive patch (patch) with daily combined hormonal contraceptive pills (pills) in adolescents. DESIGN Prospective longitudinal study of adolescents' self-selected (non-randomized) use of the patch or pills. SETTING Urban, university hospital-affiliated, adolescent outpatient clinic. PARTICIPANTS 13-22-year-old female adolescents seeking hormonal contraception, 40 who chose the patch and 40 who chose pills. INTERVENTIONS Data were collected via self-report on paper questionnaires at three-cycle intervals for a total of up to nine cycles. MAIN OUTCOME MEASURES Method continuation, perfect use, method satisfaction, quality of life, and side effects, including menstrual changes and perceived mood changes. RESULTS After nine cycles, 38% of patch users and 60% of pill users were still using the method they had chosen at enrollment. There were no significant differences between the groups in self-reported perfect use. No differences were found in quality of life or side effects. Both patch and pill users noted menses became lighter and more predictable and reported decreased depression prior to their menses; only the pill group reported improvement in premenstrual anger. Method satisfaction was similar in both groups except patch users were more likely to report that their contraceptive method improved normal daily activities. CONCLUSIONS Despite apparent advantages of the patch over the pill, adolescents using both methods continue to face challenges achieving perfect and sustained contraceptive use.
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Affiliation(s)
- Gina S Sucato
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
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Miller MK, Plantz DM, Dowd MD, Mollen CJ, Reed J, Vaughn L, Gold MA. Pediatric emergency health care providers' knowledge, attitudes, and experiences regarding emergency contraception. Acad Emerg Med 2011; 18:605-12. [PMID: 21676058 DOI: 10.1111/j.1553-2712.2011.01079.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The objective was to describe knowledge, attitudes, and experiences regarding emergency contraception (EC) among pediatric emergency health care providers (HCPs). METHODS This multicenter, focus group study elicited thoughts and experiences from pediatric emergency HCPs about EC. Participants were physicians, nurse practitioners (NPs), and nurses in one of three urban, geographically distinct, pediatric emergency departments (EDs). A professional moderator used a semistructured format for sessions, which were audiotaped, transcribed, and analyzed for recurrent themes. Participants provided demographic information and completed a written survey evaluating EC knowledge. RESULTS Eighty-five HCPs (41 physicians, eight NPs, and 36 nurses) participated in 12 focus groups. Overall knowledge about EC was poor. Participants identified barriers including cost, privacy, knowledge, and provider refusal. Provision of EC for adolescents was supported by the majority of physicians and NPs; however, many nurses were not supportive, especially following consensual intercourse. The authors identified use of social judgment by nurses as a novel barrier to EC provision. The majority of HCPs did not support screening for potential EC need. The majority of physicians and NPs felt obligated to provide adolescents with all contraceptive options, while more nurses supported provider refusal to provide EC. CONCLUSIONS This study identified important HCP perceptions and barriers about EC provision in the pediatric ED. These findings may inform future efforts to improve EC provision for adolescents. Specifically, future studies to evaluate the differences in attitudes between nurses, physicians, and NPs, and the use of social judgment in EC provision, are warranted.
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Affiliation(s)
- Melissa K Miller
- Division of Emergency Medical Services, Children's Mercy Hospital, Kansas City, MO, USA.
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Ridenour TA, Caldwell LL, Coatsworth JD, Gold MA. Directionality Between Tolerance of Deviance and Deviant Behavior is Age-Moderated in Chronically Stressed Youth. J Child Adolesc Subst Abuse 2011; 2:184-204. [PMID: 22180721 DOI: 10.1080/1067828x.2011.555278] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Problem behavior theory posits that tolerance of deviance is an antecedent to antisocial behavior and substance use. In contrast, cognitive dissonance theory implies that acceptability of a behavior may increase after experiencing the behavior. Using structural equation modeling, this investigation tested whether changes in tolerance of deviance precede changes in conduct disorder criteria or substance use or vice versa, or if they change concomitantly. Two-year longitudinal data from 246 8- to 16-year-olds suggested that tolerance of deviance increases after conduct disorder criteria or substance use in 8-to-10- and 11-to-12-year-olds. These results were consistent with cognitive dissonance theory. In 13-to-16- year-olds, no directionality was suggested, consistent with neither theory. These results were replicated in boys and girls and for different types of conduct disorder criteria aggression (covert behavior), deceitfulness and vandalism (overt behavior), and serious rule-breaking (authority conflict). The age-specific directionality between tolerance of deviance and conduct disorder criteria or substance use is consistent with unique etiologies between early onset versus adolescent-onset subtypes of behavior problems.
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