An Electronic Teen Questionnaire, the eTeenQ, for Risk Behavior Screening During Adolescent Well Visits in an Integrated Health System: Development and Pilot Implementation

Background

Screening for risk behaviors is a routine and essential component of adolescent preventive health visits. Early identification of risks can inform targeted counseling and care. If stored in discrete fields in the electronic health record (EHR), adolescent screening data can also be used to understand risk behaviors across a clinic or health system or to support quality improvement projects.

Objective

Goals of this pilot study were to adapt and implement an existing paper adolescent risk behavior screening tool for use as an electronic data capture tool (the eTeenQ), to evaluate acceptance of the eTeenQ, and to describe the prevalence of the selected risk behaviors reported through the eTeenQ.

Methods

The multidisciplinary project team applied an iterative process to develop the 29-item eTeenQ. Two unique data entry forms were created with attention to (1) user interface and user experience, (2) the need to maintain patient privacy, and (3) the potential to transmit and store data for future use in clinical care and research. Three primary care clinics within a large health system piloted the eTeenQ from August 17, 2020, to August 27, 2021. During preventive health visits for adolescents aged 12 to 18 years, the eTeenQ was completed on tablets and responses were converted to a provider display for teens and providers to review together. Responses to the eTeenQ were stored in a REDCap (Research Electronic Data Capture; Vanderbilt University) database, and for patients who agreed, responses were transferred to an EHR flowsheet. Responses to selected eTeenQ questions are reported for those consenting to research. At the conclusion of the pilot, the study team conducted semistructured interviews with providers and staff regarding their experience using the eTeenQ.

Results

Among 2816 adolescents with well visits, 2098 (74.5%) completed the eTeenQ. Of these, 1811 (86.3%) agreed to store responses in the EHR. Of 1632 adolescents (77.8% of those completing the eTeenQ) who consented for research and remained eligible, 1472 (90.2%) reported having an adult they can really talk to and 1510 (92.5%) reported feeling safe in their community, yet 401 (24.6%) reported someone they lived with had a gun and 172 (10.5%) reported having had a stressful or scary event that still bothered them. In addition, 157 (9.6%) adolescents reported they were or wondered if they were gay, lesbian, bisexual, pansexual, asexual, or other, and 43 (2.6%) reported they were or wondered if they were transgender or gender diverse. Of 11 staff and 7 providers completing interviews, all felt that the eTeenQ improved confidentiality and willingness among adolescents to answer sensitive questions. All 7 providers preferred the eTeenQ over the paper screening tool.

Conclusions

Electronic capture of adolescent risk behaviors is feasible in a busy clinic setting and well accepted among staff and clinicians. Most adolescents agreed for their responses to risk behavior screening to be stored in the EHR.

Examining the Longitudinal Connection Between Adolescent Delinquency and Risky Sexual Behaviors in a Sample of Males and Females

Adolescence is a time period that is highlighted by widespread involvement in delinquent behaviors. The long-term consequences associated with engaging in such behaviors is not entirely understood. There is some research showing, though, that adolescents who are involved in delinquency are at-risk for also engaging in an assortment of risky sexual behaviors. Whether this association is causal or the result of selection/confounding remains unclear. The current study sought to add to the literature on this topic by examining whether measures of adolescent delinquency predict later-life involvement in risky sexual behaviors (number of sexual partners, number of one-night stands, and being diagnosed with a sexually transmitted infection) in a sample from the United States. To do so, data drawn from the National Longitudinal Study of Adolescent to Adult Health (Add Health) were analyzed (N ranging from 5018 to 5964). The results revealed statistically significant associations between adolescent delinquency and risky sexual behaviors for males and females even after controlling for levels of self-control, exposure to peer substance use, parental socialization, and neighborhood disadvantage. These results suggest that the association between delinquent involvement and risky sexual behaviors is robust and future research should begin to systematically examine the developmental nature of this association.

Findings From the Step Up, Test Up Study of an Electronic Screening and Brief Intervention for Alcohol Misuse in Adolescents and Young Adults Presenting for HIV Testing: Randomized Controlled Efficacy Trial

BACKGROUND

Substance use, particularly binge drinking of alcohol and noninjection substance use, is associated with increased risk for HIV infection among youth, but structured substance use screening and brief intervention are not often provided as part of HIV risk reduction.

OBJECTIVE

The purpose of the study was to test the efficacy of a fully automated electronic screening and brief intervention, called Step Up, Test Up, to reduce alcohol misuse among adolescents and young adults presenting for HIV testing. Secondary objectives were reduction in sexual risk and uptake of pre-exposure prophylaxis (PrEP) for HIV prevention.

METHODS

Youth aged 16 years to 25 years who presented for HIV testing at community-based locations were recruited for study participation. Those who screened at moderate to high risk on the Alcohol Use Disorders Identification Test were randomized (1:1) to either an electronic brief intervention or a time-attention control. The primary outcome was change in alcohol use at 1, 3, 6, and 12-month follow-ups. Negative binomial and log binomial regression analyses with generalized estimating equations were conducted to evaluate the intervention efficacy.

RESULTS

Among a sample of 329 youth, there were no significant differences in alcohol use outcomes between conditions over time or at the 1, 3, 6, or 12-month time points. In terms of secondary outcomes, there was evidence of reduction in condomless insertive anal sex under the influence of alcohol and drugs at 12 months compared with 3 months in the intervention versus the attention control condition (incidence rate ratio=0.15, 95% CI 0.05-0.44); however, there were no other significant differences in sexual risk and no difference in PrEP engagement.

CONCLUSIONS

We found no effect of electronic brief intervention to reduce alcohol use and some effect on sexual risk among youth aged 16 years to 25 years who present for HIV testing.

TRIAL REGISTRATION

ClinicalTrials.gov number NCT02703116; https://clinicaltrials.gov/ct2/show/NCT02703116.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1186/s12889-020-8154-6.

Touchscreen-based assessment of risky-choice in mice

Addictions are characterized by choices made to satisfy the addiction despite the risk it could produce an adverse consequence. Here, we developed a murine version of a 'risky decision-making' task (RDT), in which mice could respond on a touchscreen panel to obtain either a large milkshake reward associated with varying probability of footshock, or a smaller amount of the same reward that was never punished. Results showed that (the following font is incorrectly smaller/subscripted) mice shifted choice from the large to small reward stimulus as shock probability increased. Immunohistochemical analysis revealed more Fos-positive cells in prelimbic cortex (PL) and basal amygdala (BA) after RDT testing, and a strong anti-correlation between infralimbic cortex (IL) activity and choice of the large reward stimulus under likely (75-100 % probability) punishment. These findings establish an assay for risky choice in mice and provide preliminary insight into the underlying neural substrates.

Alcohol Harms over a Period of Alcohol Policy Reform: Surveys of New Zealand College Residents in 2004 and 2014

Background: We estimated the change in the prevalence of harms attributed by students to their drinking and to others’ drinking, over a decade of concerted effort by university authorities to reduce antisocial behaviour and improve student safety. Interventions included a security and liaison service, a stricter code of conduct, challenges to liquor license applications near campus, and a ban on alcohol advertising. Methods: We used a pre-post design adjusting for population changes. We invited all students residing in colleges of a New Zealand University to complete web surveys in 2004 and 2014, using identical methods. We estimated change in the 4-week prevalence of 15 problems and harms among drinkers, and nine harms from others’ drinking among all respondents. We adjusted for differences in sample sociodemographic characteristics between surveys. Results: Among drinkers there were reductions in several harms, the largest being in acts of vandalism (7.1% to 2.7%), theft (11% to 4.5%), and physical aggression (10% to 5.3%). Among all respondents (including non-drinkers), there were reductions in unwanted sexual advances (14% to 8.9%) and being the victim of sexual assault (1.0% to 0.4%). Conclusion: Alcohol-related harm, including the most serious outcomes, decreased substantially among college residents in this period of alcohol policy reform. In conjunction with evidence of reduced drinking to intoxication in this population, the findings suggest that strategies to reduce the availability and promotion of alcohol on and near campus can substantially reduce the incidence of health and social harms.

Selfies: A boon or bane?

Background:

Selfie deaths have become an emerging problem and we performed this study to assess the epidemiology of selfie-related deaths across the globe.

Subject and Methods:

We performed a comprehensive search for keywords such as “selfie deaths; selfie accidents; selfie mortality; self photography deaths; koolfie deaths; mobile death/accidents” from news reports to gather information regarding selfie deaths.

Results:

From October 2011 to November 2017, there have been 259 deaths while clicking selfies in 137 incidents. The mean age was 22.94 years. About 72.5% of the total deaths occurred in males and 27.5% in females. The highest number of incidents and selfie-deaths has been reported in India followed by Russia, United States, and Pakistan. Drowning, transport, and fall form the topmost reasons for deaths caused by selfies. We also classified reasons for deaths due to selfie as risky behavior or non-risky behavior. Risky behavior caused more deaths and incidents due to selfies than non-risky behavior. The number of deaths in females is less due to risky behavior than non-risky behavior while it is approximately three times in males.

Conclusion:

“No selfie zones” areas should be declared across tourist areas especially places such as water bodies, mountain peaks, and over tall buildings to decrease the incidence of selfie-related deaths.

Learned Helplessness and Sexual Risk Taking in Adolescent and Young Adult African American Females

Research involving adolescent and young African American (AA) females has demonstrated that they face uncontrollable obstacles which can interfere with the negotiation of safer sexual behaviors. If these obstacles are perceived as uncontrollable, then these females may be at risk for the development of Learned Helplessness (LH). As the LH model predicts, if these obstacles are believed not to be in their control, it may lead to deficits in motivational or cognitive decision-making, deficits that could certainly influence their sexual risk taking behaviors. Therefore, the primary objective for this pilot study was to trial the Learned Helplessness Scale (LHS) to examine the perceptions of LH in this population. A convenience sample of 50 adolescent and young AA females between the ages of 16 and 21 were recruited from two clinics in Southeast Michigan. Scores on the LHS ranged from 20 to 57, with a mean score of 39.1 (standard deviation = 10.49). The higher range of scores in the sample demonstrates a continuum of LH among the participants in the study.

Adolescent cannabis use and repeated voluntary unprotected sex in women

BACKGROUND AND AIMS

Substance use has been implicated in the onset and maintenance of risky sexual behaviors, which have particularly devastating consequences in young women. This study examined whether (i) adolescent onset of cannabis use is associated with repeated voluntary unprotected sex in women and (ii) whether this association persists after accounting for correlated familial influences.

DESIGN

General population sample of female twins.

SETTING

Midwestern United States.

PARTICIPANTS

A total of 2784 sexually active twin women (15.5% African American) aged 18-27 years (assessed 2002-05), including 119 dizygotic (DZ) and 115 monozygotic (MZ) discordant pairs.

MEASUREMENTS

Self-report interview data on cannabis use that first occurred prior to age 17 (27.1%) and repeated voluntary unprotected sex (27.2%). Key covariates included early onset of regular drinking, regular smoking, sexual debut and menstruation as well as conduct disorder symptoms and childhood sexual abuse.

FINDINGS

Compared with never users and those who started using cannabis at a later age, adolescent cannabis users were more likely to report repeated voluntary unprotected sex [odds ratio (OR) = 2.69; 95% confidence interval (CI) = 2.24-3.22]. Genetic (r_g  = 0.57, 95% CI = 0.38-0.87) and non-shared environmental (r_e  = 0.21, 95% CI = 0.02-0.38) factors contributed to the association. After accounting for correlated familial factors, there was a consistent elevation in the likelihood of repeated voluntary unprotected sex in the exposed twin relative to her genetically identical never/late-onset user co-twin (unadjusted OR = 2.25, 95% CI = 1.14-4.44), even after adjustment for covariates (adjusted OR = 2.27, 95% CI = 1.08-4.80).

CONCLUSIONS

Women who start using cannabis during adolescence appear to be more likely to report voluntary engagement in repeated unprotected sex than women who never use cannabis or who initiate cannabis use after adolescence. The results appear to be independent of shared genetic influences.

Food safety in home kitchens: a synthesis of the literature

Although foodborne illness is preventable, more than 56,000 people per year become ill in the U.S., creating high economic costs, loss of productivity and reduced quality of life for many. Experts agree that the home is the primary location where foodborne outbreaks occur; however, many consumers do not believe the home to be a risky place. Health care professionals need to be aware of consumers' food safety attitudes and behaviors in the home and deliver tailored food safety interventions that are theory-based. Thus, the purpose of this paper is to synthesize/summarize the food safety literature by examining the following: consumers' perceptions and attitudes towards food safety and their susceptibility to foodborne illness in the home, work, and school; common risky food safety practices and barriers to handling food safely; and the application of theory-based food safety interventions. Findings will help healthcare professionals become more aware of consumers' food safety attitudes and behaviors and serve to inform future food safety interventions.