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Raney JH, Weinstein S, Ganson KT, Testa A, Jackson DB, Pantell M, Glidden DV, Brindis CD, Nagata JM. Mental Well-Being Among Adversity-Exposed Adolescents During the COVID-19 Pandemic. JAMA Netw Open 2024; 7:e242076. [PMID: 38477919 PMCID: PMC10938185 DOI: 10.1001/jamanetworkopen.2024.2076] [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] [Received: 09/29/2023] [Accepted: 01/22/2024] [Indexed: 03/14/2024] Open
Abstract
Importance Further research is needed to understand factors associated with well-being during the COVID-19 pandemic among adolescents who have experienced adverse childhood experiences (ACEs). Objective To explore factors associated with improved mental health during the COVID-19 pandemic among adolescents who have experienced ACEs. Design, Setting, and Participants This cross-sectional study used data from the baseline (2016-2018) and sixth (March 2021) COVID Rapid Response Research (RRR) surveys of the Adolescent Brain Cognitive Development study, which includes 21 sites across the US. Adolescents aged 11 to 15 years who completed the COVID RRR mental health measures were included. Data analyses were conducted from June to August 2023. Exposures School-based factors (eg, in-person school) and 8 coping behaviors (eg, exercise). Main Outcomes and Measures The primary outcomes were adolescent-reported positive affect (PA) and perceived stress (PS). Adolescents were stratified by no ACEs, low-to-intermediate ACEs (1-3), and high ACEs (≥4). Linear regressions estimated associations between factors and mental health, adjusting for potential confounders. Unstandardized beta coefficients (B) were compared with equality of coefficients tests. Results The 4515 adolescents in this study (mean [SD] age, 13.3 [0.88] years; 51% [95% CI, 50% to 53%] female) were racially and ethnically diverse (American Indian/Alaska Native, 2% [95% CI, 2% to 3%]; Asian, 8% [95% CI, 7% to 9%]; Black, 11% [95% CI, 10% to 12%]; Latino or Hispanic, 17% [95% CI, 15% to 18%]; White, 61% [95% CI, 60% to 63%]; other, 1% [95% CI, 0% to 2%]). For youths with high ACEs, caring for one's body (PA B = 4.02 [95% CI, 1.39 to 6.66]; PS B = -0.92 [95% CI, -1.84 to 0.00]), exercising (PA B = 3.19 [95% CI, 0.46 to 5.92]; PS B = -1.41 [95% CI, -2.40 to -0.43]), and engaging in healthy behaviors (PA B = 4.07 [95% CI, 1.28 to 6.84]; PS B = -1.01 [95% CI, -1.98 to -0.05]) were associated with higher PA and lower PS scores. In-person schooling had a greater impact on PA scores for youths with high ACEs (B = 5.55 [95% CI, 2.08 to 9.01]) than youths with low-to-intermediate ACEs (B = 1.27 [95% CI, 0.27 to 2.27]). Conclusions and Relevance These findings suggest that in-person schooling and several coping behaviors (caring for one's body, exercising, and engaging in healthy behaviors) were associated with significantly higher PA and lower PS during the COVID-19 pandemic among adolescents with high ACEs. Adolescents with high ACEs demonstrated especially greater mental health scores when they reported in-person schooling. Future studies should build on these findings to identify clinical and school-based mental health protective factors for adolescents with high ACE risk.
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Affiliation(s)
- Julia H. Raney
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco
| | | | - Kyle T. Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Alexander Testa
- Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston, Houston
| | - Dylan B. Jackson
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Matthew Pantell
- Division of Hospital Medicine, Department of Pediatrics, University of California, San Francisco
| | - David V. Glidden
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Claire D. Brindis
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
| | - Jason M. Nagata
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco
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Mangurian C, Brindis CD. Take these steps to accelerate the path to gender equity in health sciences. Nature 2024; 627:S21. [PMID: 38480972 DOI: 10.1038/d41586-024-00757-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
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Decker MJ, Gutmann-Gonzalez A, Saphir M, Nguyen NT, Zhi Q, Brindis CD. Integrated Theory-Based Health and Development Interventions for Young People: A Global Scoping Review. Health Educ Behav 2024; 51:82-93. [PMID: 36314359 PMCID: PMC10785565 DOI: 10.1177/10901981221130734] [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] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
BACKGROUND Most health and developmental issues affecting young people are interrelated. However, few interventions address multiple behavioral domains simultaneously or are based on theories that encompass a holistic perspective of youth development. AIM The purpose of this scoping review was to identify and describe the range of theory-based, multibehavioral health interventions aimed at improving two or more of the following behavioral youth outcomes: (1) sexual and reproductive health; (2) education and employment; (3) violence; and (4) substance use. METHODS Interventions conducted worldwide and published in English or Spanish between January 2000 and July 2020 were identified using four databases: PubMed, PsycINFO, LILACS, and SciELO. RESULTS A total of 11,084 articles were identified, of which 477 were retrieved and assessed for eligibility. Twenty-three articles (evaluating 21 interventions) ultimately met the inclusion criteria. Most interventions were conducted in the United States and addressed two behavioral domains of interest, although seven interventions incorporated three domains, and one incorporated all four. Substance use was the most common domain (16 interventions) but only in the United States/Canada, followed by sexual and reproductive health (14 interventions). All produced significant improvement in at least one outcome or for at least one subgroup of youth. The most common theoretical foundations were positive youth development and social learning theory. CONCLUSION Integrated interventions that are theory based and evidence informed can support positive development and empower youth to make healthy decisions. Further efforts are needed to address structural and policy issues that affect young people's developmental opportunities and health outcomes.
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Affiliation(s)
| | | | - Melissa Saphir
- University of California, San Francisco, San Francisco, CA, USA
| | | | - Qi Zhi
- University of Hawaiʻi at Mānoa, Honolulu, HI, USA
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Potter MB, Mansur S, Rutman SP, Brindis CD. Is team science valued in the academic promotions process? A mixed-methods case study. J Clin Transl Sci 2024; 8:e28. [PMID: 38384922 PMCID: PMC10880000 DOI: 10.1017/cts.2024.7] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/19/2023] [Accepted: 01/05/2024] [Indexed: 02/23/2024] Open
Abstract
Introduction Traditionally, research institutions have valued individual achievements such as principal investigator and lead authorship status as primary indicators in the academic promotions process. However, the scientific process increasingly requires collaboration by teams of researchers across multiple disciplines, sometimes including experts outside academia, often referred to as "team science." We sought to determine whether there is agreement about what constitutes team science at our academic institution and whether current promotion processes sufficiently incentivize faculty participation in team science. Methods We conducted 20 qualitative interviews with academic leaders (N = 24) at the University of California, San Francisco (UCSF) who supervise faculty promotions processes. Participants were asked to share their definitions of team science and the extent to which faculty receive credit for engaging in these activities during the promotions process. A subset of participants also completed a brief survey in which they ranked the importance of participation in team science relative to other factors that are traditionally valued in the promotions process. Interview data were examined by two analysts using structural coding. Descriptive analyses were conducted of survey responses. Results Though team science is valued at UCSF, definitions of team science and the approach to assigning credit for team science in academic promotions processes varied widely. Participants suggested opportunities to bolster support for team science. Conclusions Efforts to define and provide transparent faculty incentives for team science should be prioritized at institutions, like UCSF, seeking to advance faculty engagement in collaborative research.
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Affiliation(s)
- Michael B. Potter
- Clinical and Translational Science Institute, University of California, San Francisco, CA, USA
| | - Saji Mansur
- Clinical and Translational Science Institute, University of California, San Francisco, CA, USA
| | - Shira P. Rutman
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
| | - Claire D. Brindis
- Clinical and Translational Science Institute, University of California, San Francisco, CA, USA
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
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Mitchell A, Gutmann-Gonzalez A, Brindis CD, Decker MJ. Contraceptive access experiences and perspectives of Mexican-origin youth: a binational qualitative study. Sex Reprod Health Matters 2023; 31:2216527. [PMID: 37335382 DOI: 10.1080/26410397.2023.2216527] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
Access to comprehensive contraceptive services for youth is essential to improving sexual and reproductive health. However, youth in many countries still face substantial obstacles to contraceptive access and use. The purpose of this study is to compare the contraceptive access experiences and perspectives of pregnant and parenting Mexican-origin youth in Guanajuato, Mexico, and Fresno County, California. Focus groups and in-depth interviews were conducted in Spanish and English among female youth in Mexico (n = 49) and California (n = 25). Participants also completed a brief sociodemographic survey. Using a modified grounded theory approach, qualitative data were coded and thematically analysed based on Penchansky and Thomas's Theory of Access, and results were compared by location. Although knowledge of a service provider was high among youth in both locations, access was affected by social, cultural, and institutional dynamics and contraceptive use was mixed. Across locations, participants described obstacles to accessing their preferred method. Participants worried about parental and peer opinions about their use of contraception (acceptability), and about perceived side effects including infertility and pain (adequacy). Contextual differences included lack of contraceptive choice in Guanajuato (availability) and incomplete knowledge about options in Fresno County (awareness). The power to request and receive their method of choice (agency) emerged as an important dimension that was not part of the original theory. Latina youth living in Mexico and the United States face multiple challenges accessing needed contraceptive options and services. Recognising and reducing these barriers can strengthen the contraceptive care landscape and promote the reproductive health and agency of young people. DOI: 10.1080/26410397.2023.2216527Plain language summary: Although sexually active youth need access to comprehensive sexual and reproductive health services, youth in many countries face substantial barriers to care. This study compares the experiences of pregnant and parenting youth in accessing contraceptive services in Mexico and the United States. We conducted interviews and focus groups with 74 Mexican-origin young women and found that contraceptive use and access was affected by their concerns about parental and peer opinions as well as by provider attitudes. In Mexico, several participants reported being denied their preferred method by their provider. Identifying and addressing barriers to services can improve the quality of care and the reproductive health of young people.
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Affiliation(s)
- Ashley Mitchell
- Graduate Student Researcher, Institute for Global Health Sciences, University of California, San Francisco, CA, USA
| | - Abigail Gutmann-Gonzalez
- Project Director, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
| | - Claire D Brindis
- Distinguished Professor, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
| | - Martha J Decker
- Associate Professor, Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
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Rutman SP, Borgen N, Spellen S, King DD, Decker MJ, Rand L, Cobbins A, Brindis CD. Addressing anti-black racism in an academic preterm birth initiative: perspectives from a mixed methods case study. BMC Public Health 2023; 23:2039. [PMID: 37853363 PMCID: PMC10585806 DOI: 10.1186/s12889-023-16812-3] [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] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/21/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Growing recognition of racism perpetuated within academic institutions has given rise to anti-racism efforts in these settings. In June 2020, the university-based California Preterm Birth Initiative (PTBi) committed to an Anti-Racism Action Plan outlining an approach to address anti-Blackness. This case study assessed perspectives on PTBi's anti-racism efforts to support continued growth toward racial equity within the initiative. METHODS This mixed methods case study included an online survey with multiple choice and open-ended survey items (n = 27) and key informant interviews (n = 8) of leadership, faculty, staff, and trainees working within the initiative. Survey and interview questions focused on perspectives about individual and organizational anti-racism competencies, perceived areas of initiative success, and opportunities for improvement. Qualitative interview and survey data were coded and organized into common themes within assessment domains. RESULTS Most survey respondents reported they felt competent in all the assessed anti-racism skills, including foundational knowledge and responding to workplace racism. They also felt confident in PTBi's commitment to address anti-Blackness. Fewer respondents were clear on strategic plans, resources allocated, and how the anti-racism agenda was being implemented. Suggestions from both data sources included further operationalizing and communicating commitments, integrating an anti-racism lens across all activities, ensuring accountability including staffing and funding consistent with anti-racist approaches, persistence in hiring Black faculty, providing professional development and support for Black staff, and addressing unintentional interpersonal harms to Black individuals. CONCLUSIONS This case study contributes key lessons which move beyond individual-level and theoretical approaches towards transparency and accountability in academic institutions aiming to address anti-Black racism. Even with PTBi's strong commitment and efforts towards racial equity, these case study findings illustrate that actions must have sustained support by the broader institution and include leadership commitment, capacity-building via ongoing coaching and training, broad incorporation of anti-racism practices and procedures, continuous learning, and ongoing accountability for both short- and longer-term sustainable impact.
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Affiliation(s)
- Shira P Rutman
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA.
| | - Natasha Borgen
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
| | - Solaire Spellen
- Department of Obstetrics, Gynecology and Reproductive Sciences, California Preterm Birth Initiative, University of California, San Francisco, San Francisco, CA, USA
| | - Dante D King
- Department of Obstetrics, Gynecology and Reproductive Sciences, California Preterm Birth Initiative, University of California, San Francisco, San Francisco, CA, USA
| | - Martha J Decker
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Larry Rand
- Department of Obstetrics, Gynecology and Reproductive Sciences, California Preterm Birth Initiative, University of California, San Francisco, San Francisco, CA, USA
| | - Alexis Cobbins
- Department of Obstetrics, Gynecology and Reproductive Sciences, California Preterm Birth Initiative, University of California, San Francisco, San Francisco, CA, USA
| | - Claire D Brindis
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
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Adams SH, Park MJ, Brindis CD, Irwin CE. Adolescents' Receipt of Care in a Medical Home: Results From a National Survey. J Adolesc Health 2023; 73:790-794. [PMID: 37367704 DOI: 10.1016/j.jadohealth.2023.05.019] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 05/17/2023] [Accepted: 05/19/2023] [Indexed: 06/28/2023]
Abstract
PURPOSE Despite long-term emphasis on the medical home for children, little research focuses on adolescents. This study examines adolescent past-year attainment of medical home, its components, and subgroup differences among demographic and mental/physical health condition categories. METHODS Utilizing the 2020-21 National Survey of Children's Health (NSCH), ages 10-17 (N = 42,930), we determined medical home attainment and its 5 components and subgroup differences utilizing multivariable logistic regression: sex; race/ethnicity; income; caregiver education; insurance; language spoken at home; region; and health conditions: physical, mental, both, or none. RESULTS Forty-five percent had a medical home with lower rates among those who were as follows: not White non-Hispanic; lower income; uninsured; in non-English-speaking households; adolescents whose caregivers lacked a college degree; and adolescents with mental health conditions (p range = .01-<.0001). Differences for medical home components were similar. DISCUSSION Given low medical home rates, ongoing differences and high mental illness rates, efforts are needed to improve adolescent medical home access.
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Affiliation(s)
- Sally H Adams
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, California.
| | - M Jane Park
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, California
| | - Claire D Brindis
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, California; Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California
| | - Charles E Irwin
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, California
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Congdon JL, Bardach NS, Franck LS, Brindis CD, Boscardin WJ, Carrasco Z, Cabana MD, Dehlendorf C. Postpartum Family Planning in Pediatrics: A Survey of Parental Contraceptive Needs and Health Services Preferences. Acad Pediatr 2023; 23:1417-1425. [PMID: 36958531 DOI: 10.1016/j.acap.2023.03.009] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 03/15/2023] [Accepted: 03/17/2023] [Indexed: 03/25/2023]
Abstract
OBJECTIVE Infant well-child visits are increasingly being explored as opportunities to address parental postpartum health needs, including those related to reproductive health. To inform potential pediatric clinic-based interventions, this study assessed postpartum contraceptive needs and health services preferences. METHODS We surveyed postpartum individuals attending 2 to 6-month well-child visits at three Northern California pediatric clinics (2019-20). We examined unmet contraceptive needs; the acceptability of contraceptive education, counseling, and provision at well-child visits; and sociodemographic and clinical correlates. We conducted univariate and multivariable regression modeling to assess associations between sociodemographic and clinical variables, the status of contraceptive needs, and acceptability measures. RESULTS Study participants (n = 263) were diverse in terms of race and ethnicity (13% Asian, 9% Black, 37% Latinx, 12% Multi-racial or Other, 29% White), and socioeconomic status. Overall, 25% had unmet contraceptive needs. Unmet need was more common among participants who had delivered more recently, were multiparous, or reported ≥ 1 barrier to obtaining contraception; postpartum visit attendance, education, race, and ethnicity were not associated with unmet need. Most participants deemed the following acceptable in the pediatric clinic: receiving contraceptive information (85%), discussing contraception (86%), and obtaining a contraceptive method (81%). Acceptability of these services was greater among participants with unmet contraceptive needs, better self-rated health, and private insurance (all P < .05). CONCLUSIONS A quarter of participants had unmet contraceptive needs beyond the early postpartum period. Most considered the pediatric clinic an acceptable place to address contraception, suggesting the pediatric clinic may be a suitable setting for interventions aiming to prevent undesired pregnancies and their sequelae.
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Affiliation(s)
- Jayme L Congdon
- Department of Pediatrics and Philip R. Lee Institute for Health Policy Studies (JL Congdon and NS Bardach), University of California San Francisco.
| | - Naomi S Bardach
- Department of Pediatrics and Philip R. Lee Institute for Health Policy Studies (JL Congdon and NS Bardach), University of California San Francisco.
| | - Linda S Franck
- Department of Family Health Care Nursing (LS Franck), University of California San Francisco, School of Nursing.
| | - Claire D Brindis
- Adolescent and Young Adult Health National Resource Center and Philip R. Lee Institute for Health Policy Studies (CD Brindis), University of California, San Francisco.
| | - W J Boscardin
- Departments of Medicine and Epidemiology and Biostatistics (WJ Boscardin), University of California San Francisco.
| | - Zoe Carrasco
- School of Nursing (Z Carrasco), University of California San Francisco.
| | - Michael D Cabana
- Department of Pediatrics (MD Cabana), Albert Einstein College of Medicine and the Children's Hospital at Montefiore (CHAM), Bronx, NY.
| | - Christine Dehlendorf
- Department of Family and Community Medicine (C Dehlendorf), University of California San Francisco.
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Patel AI, Schmidt LA, McCulloch CE, Blacker LS, Cabana MD, Brindis CD, Ritchie LD. Effectiveness of a School Drinking Water Promotion and Access Program for Overweight Prevention. Pediatrics 2023; 152:e2022060021. [PMID: 37545466 PMCID: PMC10471511 DOI: 10.1542/peds.2022-060021] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Drinking water promotion and access shows promise for preventing weight gain. This study evaluated the impact of Water First, a school-based water promotion and access intervention on changes in overweight. METHODS Low-income, ethnically diverse elementary schools in California's Bay Area were cluster-randomized to intervention and control groups. Water First includes classroom lessons, water stations, and schoolwide water promotion over 1 school year. The primary outcome was overweight prevalence (BMI-for-age-and-sex ≥85th percentile). Students (n = 1249) in 56 fourth-grade classes in 18 schools (9 intervention, 9 control) from 2016 to 2019 participated in evaluation at baseline, 7, and 15 months. Data collection was interrupted in 8 additional recruited schools because of coronavirus disease 2019. RESULTS Of 1262 students from 18 schools, 1249 (47.4% girls; mean [SD] age, 9.6 [0.4] years; 63.4% Hispanic) were recruited. From baseline to 7 months, there was no significant difference in changes in overweight prevalence in intervention schools (-0.2%) compared to control schools (-0.4%) (adjusted ratio of odds ratios [ORs]: 0.7 [confidence interval (CI): 0.2-2.9] P = 0.68). From baseline to 15-months, increases in overweight prevalence were significantly greater in control schools (3.7%) compared to intervention schools (0.5%). At 15 months, intervention students had a significantly lower change in overweight prevalence (adjusted ratio of ORs: 0.1 [CI: 0.03-0.7] P = .017) compared to control students. There were no intervention effects for obesity prevalence. CONCLUSIONS Water First prevented increases in the prevalence of overweight, but not obesity, in elementary school students.
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Affiliation(s)
- Anisha I. Patel
- Department of Pediatrics, Stanford University, Palo Alto, California
| | - Laura A. Schmidt
- Philip R. Lee Institute for Health Policy Studies
- Department of Humanities and Social Sciences
| | | | - Lauren S. Blacker
- Department of Pediatrics, Stanford University, Palo Alto, California
| | - Michael D. Cabana
- Department of Pediatrics, Division of General Pediatrics, Albert Einstein College of Medicine, Children’s Hospital at Montefiore, Bronx, New York
| | - Claire D. Brindis
- Philip R. Lee Institute for Health Policy Studies
- Division of Adolescent and Young Adult Health, Department of Pediatrics, University of California, San Francisco, California
| | - Lorrene D. Ritchie
- Nutrition Policy Institute, University of California Division of Agriculture and Natural Resources, Davis, California
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Lakatos K, Teherani A, Thottathil SE, Gandhi S, Weiser SD, Brindis CD. A race to net zero-early lessons from healthcare's decarbonization marathon. Health Aff Sch 2023; 1:qxad006. [PMID: 38770407 PMCID: PMC11103727 DOI: 10.1093/haschl/qxad006] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 03/16/2023] [Indexed: 05/22/2024]
Abstract
Climate change poses a threat to healthcare systems; at the same time, healthcare systems contribute to a worsening climate. Climate-induced disasters are predicted to increase both the demand for healthcare services while also posing a threat to the integrity of healthcare systems' infrastructures and supply chains. Many healthcare organizations have taken initiatives to prepare for such disasters through implementing carbon emission-reduction practices and infrastructure reinforcement, through globally recognized frameworks and strategies known as Scopes 1, 2, and 3, and decarbonization. We explored the efforts of these early adopters to understand how they are thinking about and addressing climate change's impacts on healthcare. Through a process of reviewing the peer-reviewed literature, publicly available published documents, annual sustainability reports, conference presentations, and participation in a national decarbonization collaborative, we (1) provide a diverse set of examples showcasing the variety of ways healthcare systems are responding; (2) identify a set of emergent key themes to implementing decarbonization practices, such as the role of an organizational culture of iterative improvement and building systems of cross-organizational collaboration; and (3) synthesize the identifiable set of driving factors for long-term sustainability of these decarbonization efforts.
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Affiliation(s)
- Kyle Lakatos
- School of Medicine, University of California, San Francisco, San Francisco, CA 94143, United States
- Harvard Kennedy School of Government, Cambridge, MA 02138, United States
| | - Arianne Teherani
- School of Medicine, University of California, San Francisco, San Francisco, CA 94143, United States
- UC Center for Climate, Health, and Equity, University of California, CA, United States
| | - Sapna E Thottathil
- UC Center for Climate, Health, and Equity, University of California, CA, United States
| | - Seema Gandhi
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA 94143, United States
- University of California, San Francisco, San Francisco, CA 94143, United States
| | - Sheri D Weiser
- School of Medicine, University of California, San Francisco, San Francisco, CA 94143, United States
- UC Center for Climate, Health, and Equity, University of California, CA, United States
| | - Claire D Brindis
- UC Center for Climate, Health, and Equity, University of California, CA, United States
- University of California, San Francisco, San Francisco, CA 94143, United States
- Philip R. Lee Institute for Health Policy Studies, San Francisco, CA 94158, United States
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Barral RL, Brindis CD, Hornberger L, Trent M, Sherman AK, Ramirez M, Finocchario-Kessler S, Ramaswamy M. The Perfect Storm: Perceptions of Influencing Adults Regarding Latino Teen Pregnancy in Rural Communities. Matern Child Health J 2023; 27:621-631. [PMID: 36840786 PMCID: PMC10317519 DOI: 10.1007/s10995-023-03627-2] [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] [Subscribe] [Scholar Register] [Accepted: 02/15/2023] [Indexed: 02/26/2023]
Abstract
INTRODUCTION Recognition of the importance of adolescents' environments in influencing their sexual and reproductive health (SRH) decision-making necessitates a deeper understanding of the role that community stakeholders play in shaping Adolescent and Young Adults (AYA) access to SRH education and care. We describe community stakeholders' knowledge, beliefs, and attitudes about AYA's SRH needs in three rural Latino communities in Kansas. METHODS Key stakeholders completed a written survey incorporating the theory of Planned Behavior to assess attitudes, norms, and intentions to support AYA's SRH education and access to care. RESULTS Across three rural immigrant community settings, respondents (N = 55) included 8 community health workers, 9 health care providers, 7 public health officials, 19 school health officials, and 12 community members. More than half self-identified as Latino (55%). Six (11%) participants, half of whom were in the health sector, thought SRH education would increase the likelihood that teens would engage in sexual activities. In contrast, other stakeholders thought that providing condoms (17, 30.9%), contraception other than condoms (14, 25.5%), and providing HPV immunization (5, 9.6%) would increase the likelihood of engaging in sexual activity. Ambivalence regarding support for SRH education and service provision prevailed across sectors, reflected even in the endorsement of the distribution of less effective contraceptive methods. Obstacles to care include immigration status, discrimination, lack of confidential services, and transportation. CONCLUSION Key stakeholders living in rural communities revealed misconceptions, negative attitudes, and ambivalent beliefs related to the delivery of SRH education and services, potentially creating barriers to AYA's successful access to care.
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Affiliation(s)
- Romina L Barral
- Division of Adolescent Medicine, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, 3101 Broadway Blvd, Kansas City, MO, 64111, USA.
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Claire D Brindis
- Department of Pediatrics, Adolescent and Young Adult Health National Resource Center, Philip R. Lee Institute for Health Policy Studies (IHPS), University of California San Francisco, San Francisco, CA, USA
| | - Laurie Hornberger
- Division of Adolescent Medicine, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, 3101 Broadway Blvd, Kansas City, MO, 64111, USA
| | - Maria Trent
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ashley K Sherman
- Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Mariana Ramirez
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA
| | - Sarah Finocchario-Kessler
- Department of Family Medicine and Community Health, University of Kansas Medical Center, Kansas City, KS, USA
| | - Megha Ramaswamy
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA
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12
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Harper CC, Jones E, Brindis CD, Watson A, Schroeder R, Boyer CB, Edelman A, Trieu S, Yarger J. Educational Intervention Among Adolescents and Young Adults on Emergency Contraception Options. J Adolesc Health 2023; 72:993-996. [PMID: 36894464 DOI: 10.1016/j.jadohealth.2023.01.007] [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: 10/06/2022] [Revised: 12/15/2022] [Accepted: 01/04/2023] [Indexed: 03/11/2023]
Abstract
PURPOSE Emergency contraception (EC), the 'last chance' contraceptive method, has gained significance post-Roe, but most young people do not know their options. METHODS We conducted an educational intervention on EC among 1,053 students aged 18-25 years. We assessed changes in knowledge of key aspects of EC using generalized estimating equations. RESULTS At baseline, virtually no one was aware of the intrauterine device for EC (4%), but postintervention, 89% correctly identified intrauterine devices as the most effective EC (adjusted odds ratio [aOR] = 116.6; 95% confidence interval [CI] 62.4, 217.8). Knowledge that levonorgestrel pills could be accessed without a prescription grew (60%-90%; aOR = 9.7, 95% CI 6.7-14.0), as did knowledge that pills work best when taken as soon as possible (75%-95%; aOR = 9.6, 95% CI 6.1-14.9). Multivariate results showed adolescent and young adult participants absorbed these key concepts across age, gender, and sexual orientation. DISCUSSION Timely interventions are needed to empower youth with knowledge of EC options.
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Affiliation(s)
- Cynthia C Harper
- Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, California, San Francisco; Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, California, San Francisco.
| | - Erin Jones
- University of Southern California Keck School of Medicine, Los Angeles, California
| | - Claire D Brindis
- Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, California, San Francisco; Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, California, San Francisco; Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California San Francisco, California, San Francisco
| | - Annalisa Watson
- Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, California, San Francisco
| | - Rosalyn Schroeder
- Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, California, San Francisco
| | - Cherrie B Boyer
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California San Francisco, California, San Francisco
| | - Alison Edelman
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
| | - Sang Trieu
- Student Health Center, Ohlone College, Fremont, California
| | - Jennifer Yarger
- Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, California, San Francisco; Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, California, San Francisco
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13
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Rutman SP, Price M, Williams S, Jones L, Williams-Burt H, Decker MJ, Franck LS, Fuchs JD, Brindis CD. Pursuing Research Justice Through Community-Academic Partnership to Address Racial Disparities in Preterm Birth. Prog Community Health Partnersh 2023; 17:319-327. [PMID: 37462560 DOI: 10.1353/cpr.2023.a900212] [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] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
BACKGROUND The California Preterm Birth Initiative is a community-engaged research effort focused on addressing racial disparities in birth outcomes. OBJECTIVES To highlight three community-academic partnership strategies and identify partners' lessons learned and recommendations. METHODS We conducted interviews (n = 38), four focus groups (n = 23), a document review (n = 174), and meeting/event observations (n = 36). We performed content analysis and structural and emerging coding of the data, which involved extracting and sorting information into themes. LESSONS LEARNED Five themes emerged across the strategies as essential for successful partnerships addressing racial disparities: 1) incorporate a racial equity approach; 2) value community knowledge; 3) ensure accountability to community priorities; 4) build relationships and trust; and 5) address structural barriers to community-academic partnerships. CONCLUSIONS Community-academic partnerships addressing racial health disparities should confront internal and structural power dynamics early on and support affected communities to lead the efforts, including committing to funding and capacity-building activities to ensure research justice.
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Wesevich A, Jiao MG, Santanam TS, Chung RJ, Uchitel J, Zhang Q, Brindis CD, Ford CA, Counts NZ, Wong CA. Adolescent and Young Adult Perspectives on Quality and Value in Health Care. Acad Pediatr 2022; 23:782-789. [PMID: 36288750 DOI: 10.1016/j.acap.2022.10.010] [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: 06/26/2022] [Revised: 10/12/2022] [Accepted: 10/15/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe adolescent and young adult (AYA) perspectives on defining quality and value in health care and to gain understanding of their knowledge of value-based payment. METHODS A text message-based survey was sent to a convenience sample of AYAs aged 14 to 24 in 2019. Participants were asked 4 open-ended questions: 1) how they would define "good health care," 2) what factors to consider in rating doctors, 3) whose opinions should matter most when rating doctors, and 4) the best ways to collect AYA opinions on doctors, and one yes/no question on their awareness of value-based payment. Analyses included descriptive demographic statistics and an inductive thematic approach with multivariable models comparing adolescent (14-18) and young adult (19-24) responses. RESULTS Response rate was 61.0% (782/1283). Most participants were White (63.3%), female (53.3%), and adolescents (55.6%). Common themes from the first 2 questions included accessibility (specifically affordability), coverage benefits, and care experience (including compassion, respect, and clinical competence). Young adults more commonly mentioned affordability than adolescents (54.4% vs 43.3%, P = .001) and more commonly felt their opinion should matter more than their parents when rating doctors (80.6% vs 62.0%, P < .001). Only 21.0% of AYAs were familiar with the potential value-based link between physician payment and care quality. CONCLUSIONS When considering quality and value in health care, AYAs expressed their desired agency in rating the quality of their care and clinicians. AYAs' perspectives on health care quality, including the importance of care accessibility and affordability, should be considered when designing youth-centered care delivery and value-based payment models.
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Affiliation(s)
- Austin Wesevich
- Section of Hematology/Oncology, Department of Medicine, University of Chicago (A Wesevich), Chicago, Ill; Department of Medicine, Department of Pediatrics, Duke University School of Medicine (A Wesevich and RJ Chung), Durham, NC
| | - Megan G Jiao
- Duke-Margolis Center for Health Policy, Duke University (MG Jiao, TS Santanam, J Uchitel, Q Zhang, and CA Wong), Durham, NC
| | - Taruni S Santanam
- Duke-Margolis Center for Health Policy, Duke University (MG Jiao, TS Santanam, J Uchitel, Q Zhang, and CA Wong), Durham, NC
| | - Richard J Chung
- Department of Medicine, Department of Pediatrics, Duke University School of Medicine (A Wesevich and RJ Chung), Durham, NC
| | - Julie Uchitel
- Duke-Margolis Center for Health Policy, Duke University (MG Jiao, TS Santanam, J Uchitel, Q Zhang, and CA Wong), Durham, NC
| | - Qintian Zhang
- Duke-Margolis Center for Health Policy, Duke University (MG Jiao, TS Santanam, J Uchitel, Q Zhang, and CA Wong), Durham, NC
| | - Claire D Brindis
- Adolescent and Young Adult National Health Information Center and Philip R. Lee Institute for Health Policy Studies, University of California (CD Brindis), San Francisco, Calif
| | - Carol A Ford
- Division of Adolescent Medicine, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine and the Children's Hospital of Philadelphia (CA Ford), Philadelphia, Pa
| | | | - Charlene A Wong
- Duke-Margolis Center for Health Policy, Duke University (MG Jiao, TS Santanam, J Uchitel, Q Zhang, and CA Wong), Durham, NC.
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Maya S, Kahn JG, Lin TK, Jacobs LM, Schmidt LA, Burrough WB, Ghasemzadeh R, Mousli L, Allan M, Donovan M, Barker E, Horvath H, Spetz J, Brindis CD, Malekinejad M. Indirect COVID-19 health effects and potential mitigating interventions: Cost-effectiveness framework. PLoS One 2022; 17:e0271523. [PMID: 35849613 PMCID: PMC9292069 DOI: 10.1371/journal.pone.0271523] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/04/2022] [Indexed: 12/23/2022] Open
Abstract
Background The COVID-19 pandemic led to important indirect health and social harms in addition to deaths and morbidity due to SARS-CoV-2 infection. These indirect impacts, such as increased depression and substance abuse, can have persistent effects over the life course. Estimated health and cost outcomes of such conditions and mitigation strategies may guide public health responses. Methods We developed a cost-effectiveness framework to evaluate societal costs and quality-adjusted life years (QALYs) lost due to six health-related indirect effects of COVID-19 in California. Short- and long-term outcomes were evaluated for the adult population. We identified one evidence-based mitigation strategy for each condition and estimated QALYs gained, intervention costs, and savings from averted health-related harms. Model data were derived from literature review, public data, and expert opinion. Results Pandemic-associated increases in prevalence across these six conditions were estimated to lead to over 192,000 QALYs lost and to approach $7 billion in societal costs per million population over the life course of adults. The greatest costs and QALYs lost per million adults were due to adult depression. All mitigation strategies assessed saved both QALYs and costs, with five strategies achieving savings within one year. The greatest net savings over 10 years would be achieved by addressing depression ($242 million) and excessive alcohol use ($107 million). Discussion The COVID-19 pandemic is leading to significant human suffering and societal costs due to its indirect effects. Policymakers have an opportunity to reduce societal costs and health harms by implementing mitigation strategies.
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Affiliation(s)
- Sigal Maya
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, United States of America
- * E-mail:
| | - James G. Kahn
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, United States of America
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States of America
| | - Tracy K. Lin
- Institute for Health and Aging, University of California San Francisco, San Francisco, CA, United States of America
| | - Laurie M. Jacobs
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, United States of America
| | - Laura A. Schmidt
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, United States of America
- Department of Humanities and Social Sciences, University of California San Francisco, San Francisco, CA, United States of America
| | - William B. Burrough
- University of California San Francisco Benioff Children’s Hospital Oakland, Oakland, CA, United States of America
| | - Rezvaneh Ghasemzadeh
- University of California San Francisco Benioff Children’s Hospital Oakland, Oakland, CA, United States of America
| | - Leyla Mousli
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, United States of America
| | - Matthew Allan
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, United States of America
| | - Maya Donovan
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, United States of America
| | - Erin Barker
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, United States of America
| | - Hacsi Horvath
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, United States of America
| | - Joanne Spetz
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, United States of America
| | - Claire D. Brindis
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, United States of America
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, United States of America
| | - Mohsen Malekinejad
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, United States of America
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States of America
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16
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Decker MJ, Borgen N, Gutmann-Gonzalez A, Brindis CD. Youth perceptions and concerns about sexually transmissible infections versus pregnancy: a qualitative comparative study in California. Sex Health 2022; 19:439-447. [PMID: 35799331 DOI: 10.1071/sh22037] [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] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/16/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Although rates of adolescent pregnancy have been declining for decades, rates of sexually transmissible infections (STIs) continue to increase among youth. Little is known about youth's comparative concern regarding pregnancy and STIs, particularly among marginalised populations. Therefore, this study compares concerns toward unplanned pregnancy and STIs and identifies underlying reasons for these differing concerns in youth populations with elevated rates of STIs. METHODS Fourteen focus groups were held with 92 youth in two counties in California, USA. Youth were purposefully selected from community-based organisations and schools to represent a variety of backgrounds and populations with elevated rates of pregnancy and STIs. Qualitative coding and analysis were conducted using ATLAS.ti. 7.0. RESULTS Almost all participants were youth of colour (86%), 27% identified as gay, lesbian or bisexual, and 21% had ever experienced homelessness. Although most youth were generally concerned about the consequences of contracting an STI, including the possible stigma associated with it, both males and females were more worried about an unplanned pregnancy. Emergent themes included varying concerns about the lasting consequences of unplanned pregnancies and STIs; greater visibility of pregnancy compared to infection; stigma; and limited STI prevention efforts compared to teen pregnancy prevention. CONCLUSIONS By addressing the underlying concerns and varying perceptions that different groups of youth have toward STIs and pregnancy, prevention approaches and messages can be tailored, including by age, gender, sexual orientation, and for those exposed to vulnerable living situations. Additional efforts are needed to address increasing rates of STIs among young people.
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Affiliation(s)
- Martha J Decker
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA; and Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA; and Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, CA, USA
| | - Natasha Borgen
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA; and Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, CA, USA
| | - Abigail Gutmann-Gonzalez
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA; and Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, CA, USA
| | - Claire D Brindis
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA; and Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, CA, USA; and Adolescent and Young Adult Health National Resource Center, University of California, San Francisco, San Francisco, CA, USA
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17
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Sudhinaraset M, Choi HY, Nakphong MK, Woofter R, Brindis CD. Contraceptive use and consistency and the role of deferred action for childhood arrivals: A cross-sectional survey of undocumented young adults. Sex Reprod Healthc 2022; 32:100725. [PMID: 35533466 DOI: 10.1016/j.srhc.2022.100725] [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] [Received: 10/28/2021] [Revised: 03/08/2022] [Accepted: 04/10/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The Deferred Action for Childhood Arrivals (DACA) program grants young, undocumented immigrants work authorization and protections from deportation, with about 1.3 million eligible for the program. This exploratory study examines the association between DACA status and contraceptive use among undocumented young adults. STUDY DESIGN We conducted an internet-based survey between June 2017 and August 2017 among Asian and Latinx undocumented immigrants (N = 204) aged 18-31 years in California. Bivariate and multivariate logistic regressions were conducted to examine the associations between DACA status and contraceptive use and consistency. RESULTS Among undocumented participants who were sexually active, about 60% reported having unprotected sex (52% DACA vs. 63% non-DACA) and about 80% reported that documentation status affects how they access care for sexual/reproductive health at least a little. Overall, Asians were 81% less likely to have unprotected sex compared to Latinx individuals (aOR = 0.19, 95%CI: 0.06, 0.56). DACA recipients were more likely to report using contraception every time compared to non-recipients (42.9% vs. 30.5%, p = 0.04). DACA recipients were 63% less likely to report having unprotected sex in the past 12 months compared to those without DACA (aOR = 0.37, 95%CI: 0.14, 0.99). DACA recipients were more than three times as likely to use contraception during sex every time compared to those without DACA (aOR = 3.19, 95%CI: 1.19, 8.54). CONCLUSIONS This study demonstrates that undocumented young adults have low rates of contraceptive use; however, DACA is associated with improved reproductive health for certain undocumented immigrants. IMPLICATIONS AND CONTRIBUTION State and federal policies that extend protections and promote immigrant integration are needed to fully achieve reproductive justice for all.
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Affiliation(s)
- May Sudhinaraset
- Department of Community Health Sciences, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA.
| | - Hye Young Choi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Michelle Kao Nakphong
- Department of Community Health Sciences, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Rebecca Woofter
- Department of Community Health Sciences, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Claire D Brindis
- Distinguished Professor and Emerita Director, Philip R. Lee Institute for Health Policy Studies, Co-Director, Adolescent and Young Adult Health National Resource Center University of California, San Francisco, USA
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18
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Affiliation(s)
- Claire D Brindis
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California
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19
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English A, Brindis CD. Health, Safety, and Well-Being of Adolescents and Young Adults in the United States: What Is at Stake Beyond 2021? J Adolesc Health 2022; 70:175-185. [PMID: 35063149 DOI: 10.1016/j.jadohealth.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/05/2021] [Accepted: 11/05/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Abigail English
- Center for Adolescent Health & the Law, Chapel Hill, North Carolina; Gillings School of Global Public Health, UNC Chapel Hill, Chapel Hill, North Carolina.
| | - Claire D Brindis
- Division of Adolescent & Young Adult Medicine, UCSF, San Francisco, California; Adolescent and Young Adult Health National Resource Center, UCSF, San Francisco, California; Philip R. Lee Institute for Health Policy Studies, UCSF, San Francisco, California
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20
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Tebb KP, Brindis CD. Understanding the Psychological Impacts of Teenage Pregnancy through a Socio-ecological Framework and Life Course Approach. Semin Reprod Med 2022; 40:107-115. [PMID: 34991169 DOI: 10.1055/s-0041-1741518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The relationship between mental health and teenage pregnancy is complex. Mental health can be both an antecedent and contributing factor to teenage pregnancy and a concurrent factor wherein pregnancy itself can contribute to depression. Expectant and parenting teens (EPT) are faced with the simultaneous challenges of pregnancy and parenting while navigating the developmental tasks of adolescence which increases their risk for mental health problems. In addition, adolescents growing up in stressful community or home situations where their parents experienced depression, further places them and their children at greater risk of repeated patterns over time. However, adverse mental health outcomes are not inevitable. The socio-ecological model combined with a life course perspective provides a framework for understanding the complexity of risk and protective factors at multiple levels that influence knowledge, attitudes, behaviors, and other health outcomes later in life and across generations. This approach has important implications for reducing adolescents' risk of an unintended/mistimed pregnancy and improving mental health and other outcomes for EPT. This paper describes the prevalence of mental health problems in EPT and using a socio-ecological framework and life course perspective explains variations in mental health outcome among EPT. Implications for interventions and innovative approaches are also discussed.
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Affiliation(s)
- Kathleen P Tebb
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of California, California, San Francisco
| | - Claire D Brindis
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, Adolescent and Young Adult Health National Resource Center, University of California, California, San Francisco.,The Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, University of California, California, San Francisco
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21
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Decker MJ, Dandekar S, Gutmann-Gonzalez A, Brindis CD. Bridging the Gap between Sexual Health Education and Clinical Services: Adolescent Perspectives and Recommendations. J Sch Health 2021; 91:928-935. [PMID: 34523133 DOI: 10.1111/josh.13084] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 10/26/2020] [Revised: 01/11/2021] [Accepted: 01/19/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Adolescents often lack access to accurate and appropriate sexual health information and services. Providing information about local clinical services during sexual health education classes is one strategy to increase awareness, yet many programs miss this opportunity. This study aims to learn about adolescents' experiences with sexual health education and their perceptions of barriers and facilitators to clinical care. METHODS Nine focus groups were conducted between April to July 2018 with 69 adolescents who had recently attended a comprehensive sexual health education program in California. Topics included information received about local clinics during class and barriers and facilitators to access care. Qualitative data were coded and analyzed for key themes and compared by sex and geographic location. RESULTS The majority of participants (89%) were Latino and most reported receiving relevant information about clinical services and had positive impressions of local services. Several mentioned that this information increased the likelihood that they would access services if needed. Common barriers to clinic services included parental disapproval, stigma, embarrassment, and confidentiality concerns. Facilitators included peer and family support, confidentiality of services, awareness and education, and accessibility. CONCLUSIONS Sexual health education programs can provide an important bridge to local clinic services and address adolescents' concerns.
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Affiliation(s)
- Martha J Decker
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th St 2nd floor, San Francisco, CA, 94158
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 490 Illinois St, San Francisco, CA, 94107
- Bixby Center for Global Reproductive Health, University of California San Francisco, 1001 Potrero Avenue, UCSF Box 0842, San Francisco, CA, 94110
| | - Shebani Dandekar
- Loma Linda University Health, 11234 Anderson Street, Loma Linda, CA, 92354
| | - Abigail Gutmann-Gonzalez
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 490 Illinois St, San Francisco, CA, 94107
- Bixby Center for Global Reproductive Health, University of California San Francisco, 1001 Potrero Avenue, UCSF Box 0842, San Francisco, CA, 94110
| | - Claire D Brindis
- Division Adolescent and Young Adult Health, Department of Obstetrics, Gynecology, and Reproductive Health Sciences, National Resource Center, University of California San Francisco, 3333 California Street, Suite 245, San Francisco, CA, 94118
- Emerita Director, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 490 Illinois St, San Francisco, CA, 94107
- Founding Director and Senior Scholar, Bixby Center for Global Reproductive Health, University of California San Francisco, 1001 Potrero Avenue, UCSF Box 0842, San Francisco, CA, 94110
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Abstract
PURPOSE Young adults have the highest cumulative incidence of COVID-19 infection in the country. Using March 2021 Household Pulse Survey data, an ongoing, cross-sectional nationally representative survey, we examined U.S. young adult intention to accept COVID-19 vaccines. METHODS Young adult (ages 18-25 years) Household Pulse Survey participants were queried on intention to receive a COVID-19 vaccine and related perspectives (N = 5,082). RESULTS Most unvaccinated respondents (76%) indicated an intention to become vaccinated. The most frequently cited reasons for potentially rejecting vaccination included desire to wait and see if the vaccine is safe (56%); concerns over side effects (53%); and believing others are in greater need of the vaccine (44%). CONCLUSIONS With 24% of young adults hesitant to accept a COVID-19 vaccine, public health interventions should target reasons for hesitancy, address concerns about safety and side effects, and underscore the importance of vaccinations for this population.
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Affiliation(s)
- Sally H Adams
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, California
| | - Jason P Schaub
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, California; Philip R. Lee Institute For Health Policy, Studies, University of California San Francisco, San Francisco, California.
| | - Jason M Nagata
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, California
| | - M Jane Park
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, California
| | - Claire D Brindis
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, California; Philip R. Lee Institute For Health Policy, Studies, University of California San Francisco, San Francisco, California
| | - Charles E Irwin
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, California
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Barney A, Rodriguez F, Schwarz EB, Reed R, Tancredi D, Brindis CD, Dehlendorf C, Tebb KP. Adapting to Changes in Teen Pregnancy Prevention Research: Social Media as an Expedited Recruitment Strategy. J Adolesc Health 2021; 69:349-353. [PMID: 33632643 DOI: 10.1016/j.jadohealth.2020.12.140] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 06/25/2020] [Revised: 12/14/2020] [Accepted: 12/21/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE Teen pregnancy prevention projects funded by the U.S. Office of Adolescent Health were disrupted by the Trump administration in the July 2017 announcement that funding would be terminated. Although funding was later reinstated toward the end of 2018 after a class-action lawsuit, we needed to change our recruitment protocol to mitigate this disruption to the study timeline and staffing. This led to a natural experiment comparing in person and social media recruitment strategies. METHODS The original approach was to recruit girls, aged 15-19 years, who were using intrauterine or subdermal contraception, in person in clinic settings. After the funding disruption, we transitioned to an online recruitment strategy. Costs associated with each approach (in-person and online recruitment) were tracked, and we compared cost of per-person enrollment with each approach. RESULTS In-person, clinic-based recruitment enrolled 118 participants over 293 days from eight high-volume clinics. Online recruitment enrolled 518 participants over 146 days. Online recruitment resulted in cost savings and a diverse sample representing a larger geographic region. CONCLUSION Online recruitment can cut costs and be more efficient than a clinic-based recruitment strategy, but special considerations are warranted when considering social media recruitment.
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Affiliation(s)
- Angela Barney
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California San Francisco, San Francisco, California.
| | - Felicia Rodriguez
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California San Francisco, San Francisco, California
| | - Eleanor Bimla Schwarz
- Department of General Internal Medicine, University of California Davis, Davis, California
| | - Reiley Reed
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, California
| | - Daniel Tancredi
- Department of General Pediatrics, University of California Davis, Davis, California
| | - Claire D Brindis
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California
| | - Christine Dehlendorf
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, California
| | - Kathleen P Tebb
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California San Francisco, San Francisco, California
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Decker MJ, Pineda N, Gutmann-Gonzalez A, Brindis CD. Youth-centered maternity care: a binational qualitative comparison of the experiences and perspectives of Latina adolescents and healthcare providers. BMC Pregnancy Childbirth 2021; 21:349. [PMID: 33934698 PMCID: PMC8091497 DOI: 10.1186/s12884-021-03831-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 04/26/2021] [Indexed: 11/24/2022] Open
Abstract
Background Although there is growing recognition of the importance of person-centered maternity care, the needs and perspectives of pregnant adolescents are rarely considered. The purpose of this study was to compare the maternity care experiences of Mexican-origin adolescents in Guanajuato, Mexico and Fresno, California from both youth and healthcare provider perspectives. Methods Qualitative interviews and focus groups were conducted with a total of 89 respondents, including 74 pregnant and parenting adolescents as well as 15 providers between December 2016 and July 2017. Adolescents also completed a short demographic survey prior to participation. Transcripts in English and Spanish were coded and thematically analyzed using Dedoose software. Results were compared by location and between youth and providers. Results Four themes emerged regarding patient-provider interactions: the need for communication and clear explanations, respectful versus judgmental providers, engaging youth in decision-making, and a focus on the age of the youth and their partners. While youth had similar perspectives and priorities in both locations, youth in Mexico reported more negative healthcare experiences than youth in California. Perspectives varied between the youth and providers, with providers in both California and Mexico identifying several structural challenges in providing quality care to adolescents. In California, challenges to supporting immigrant Latina adolescents and their families included language and translation issues as well as barriers to care due to immigration status and documentation. In both locations, providers also mentioned high patient caseloads and their own concerns about the youth’s life choices. Conclusion Youth-centered care requires more effective and respectful patient-provider communication, where adolescents are engaged in their healthcare decision-making and delivery options. Changes in patient-provider interactions can help improve the maternity care experiences and outcomes of Latina adolescents. Healthcare systems and providers need to reconfigure their approaches to focus on the needs and priorities of adolescents. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03831-4.
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Affiliation(s)
- Martha J Decker
- Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th Street, 2nd floor, San Francisco, CA, 94158, USA.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, 490 Illinois Street, 7th floor, San Francisco, CA, 94158, USA
| | - Noelle Pineda
- Stanford University School of Medicine, Stanford University, 291 Campus Drive, Stanford, CA, 94305, USA
| | - Abigail Gutmann-Gonzalez
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, 490 Illinois Street, 7th floor, San Francisco, CA, 94158, USA.
| | - Claire D Brindis
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, 490 Illinois Street, 7th floor, San Francisco, CA, 94158, USA.,Adolescent and Young Adult Health National Resource Center, University of California, San Francisco, 3333 California Street, Suite 245, San Francisco, CA, 94143, USA
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Tebb KP, Rodriguez F, Pollack LM, Adams S, Rico R, Renteria R, Trieu SL, Hwang L, Brindis CD, Ozer E, Puffer M. Improving contraceptive use among Latina adolescents: A cluster-randomized controlled trial evaluating an mHealth application, Health-E You/Salud iTu. Contraception 2021; 104:246-253. [PMID: 33744300 DOI: 10.1016/j.contraception.2021.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 07/07/2020] [Revised: 03/03/2021] [Accepted: 03/07/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of Health-E You/Salud iTu, a mobile health application (app), on increasing knowledge, self-efficacy and contraception use among Latina adolescents, its impact on visit quality, and app satisfaction. STUDY DESIGN This study used cluster-randomized controlled trial (CRCT) of 18 school-based health centers (SBHCs). Prior to the visit, intervention participants received the patient-centered contraceptive decision-making support app and controls answered sexual health questions on iPads. Participants completed a previsit questionnaire and 3 follow-up surveys (48 hours, 3-, and 6-months) after the recruitment visit (where intervention participants completed the app). Differences in adolescents' contraceptive knowledge, self-efficacy, and use over the 6-month follow-up were assessed by generalized mixed effects regression models. RESULTS A total of 1,360 Latina adolescents participated; 57.2% responded to the 48-hour survey, 50.1% to the 3-month, 49.7% to the 6-month, and 42.3% to both the 3- and 6-month surveys. Health-E You users' demonstrated significant increases in pre-post knowledge (p < 0.001). Intervention participants who completed the follow-up survey reported greater increases in mean self-efficacy from baseline (23.2 intervention vs. 22.5 controls) to 6 months (26.1 vs. 23.4; b = 1.58, 95% CI 0.38-2.77, p = 0.01), and greater increases in non-barrier contraceptive use from baseline (29% intervention vs. 30% controls) to 3 months (63% vs. 45%; OR = 3.29, 95% CI 1.04-10.36, p = 0.04) and 6 months (63% vs. 44%; OR = 5.54, 95% CI 1.70-18.06, p = 0.005). Providers and adolescents reported high app satisfaction and stated it improved visit quality. CONCLUSIONS While data suggest that Health-E You improved outcomes, findings must be interpreted cautiously. Intervention participants had higher baseline sexual activity rates, more recruitment visits for pregnancy testing, emergency contraception or birth control, and lower completion rates of follow-up surveys than controls. IMPLICATIONS Despite declines in adolescent pregnancy in the United States, Latinas continue to have disproportionately high rates compared to white females. The Health-E You app may be an effective support tool for both adolescents and providers in SBHCs, and possibly other clinical settings, across the country to increase contraceptive use and thereby decrease unintended pregnancies. It could potentially reduce disparities in adolescent pregnancies and create more efficient visit time spent between clients and their providers.
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Affiliation(s)
- Kathleen P Tebb
- Department of Pediatrics, University of California San Francisco, CA, USA.
| | - Felicia Rodriguez
- Department of Pediatrics, University of California San Francisco, CA, USA
| | - Lance M Pollack
- Center for AIDs Prevention Studies, University of California, San Francisco, CA, USA
| | - Sally Adams
- Department of Pediatrics, University of California San Francisco, CA, USA
| | - Rosario Rico
- The Los Angeles Trust for Children's Health, Los Angeles, CA, USA
| | - Robert Renteria
- The Los Angeles Trust for Children's Health, Los Angeles, CA, USA
| | - Sang Leng Trieu
- The Los Angeles Trust for Children's Health, Los Angeles, CA, USA
| | - Loris Hwang
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Claire D Brindis
- Department of Pediatrics and the Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA
| | - Elizabeth Ozer
- Department of Pediatrics and the Office for Diversity and Outreach, University of California San Francisco, San Francisco, CA, USA
| | - Maryjane Puffer
- The Los Angeles Trust for Children's Health, Los Angeles, CA, USA
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Ralph LJ, Chaiten L, Werth E, Daniel S, Brindis CD, Biggs MA. Reasons for and Logistical Burdens of Judicial Bypass for Abortion in Illinois. J Adolesc Health 2021; 68:71-78. [PMID: 33041202 DOI: 10.1016/j.jadohealth.2020.08.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 05/13/2020] [Revised: 08/19/2020] [Accepted: 08/21/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Minors seeking abortion in states with parental involvement requirements can obtain judicial bypass (JB) as an alternative. Research on minors' reasons for choosing bypass and the logistical obstacles associated with bypass is limited, yet needed to assess potential burdens introduced by mandated parental involvement. METHODS Using data from all minors represented in JB proceedings by the Illinois Judicial Bypass Coordination Project in 2017 and 2018, we present descriptive statistics summarizing minors' demographic characteristics, reasons for seeking bypass, individuals involved in decision-making, and distances traveled and time elapsed to attend the court hearing. RESULTS Most minors obtaining bypass (n = 150) agreed to participate (n = 128). Just more than half (55%) were aged 17 years and lived with one parent (54%). A minority were already parenting (5%) and/or lived with someone besides a parent or on their own (16%). The reasons for bypass included concern about being forced to continue the pregnancy (50%), fear of being kicked out of their home and/or cut off financially (41%), having no/minimal relationship with parents (15%), and fear of physical/emotional abuse (13%). Minors traveled an average of 24 miles one-way (range 1-270 miles) to a courthouse for their hearing. On average, 6.4 days elapsed between contacting the Judicial Bypass Coordination Project and the hearing. CONCLUSIONS Judicial bypass can offer young people an opportunity to retain autonomy in decision-making, potentially avoiding abuse and other negative outcomes. However, even in a state with a well-organized network of attorneys, JB contributes 1 week to minors' abortion-seeking timeline and necessitates traveling long distances.
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Affiliation(s)
- Lauren J Ralph
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, Oakland, California.
| | - Lorie Chaiten
- Reproductive Freedom Project, American Civil Liberties Union Foundation, New York, New York
| | - Emily Werth
- Illinois Judicial Bypass Coordination Project, Roger Baldwin Foundation of ACLU, Inc, Chicago, Illinois
| | - Sara Daniel
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, Oakland, California
| | - Claire D Brindis
- Philip R. Lee Institute for Health Policy Studies, Bixby Center for Global Reproductive Health, Departments of Pediatrics and Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California
| | - M Antonia Biggs
- Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, Oakland, California
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Upadhyay UD, Danza PY, Neilands TB, Gipson JD, Brindis CD, Hindin MJ, Foster DG, Dworkin SL. Development and Validation of the Sexual and Reproductive Empowerment Scale for Adolescents and Young Adults. J Adolesc Health 2021; 68:86-94. [PMID: 32690468 PMCID: PMC7755733 DOI: 10.1016/j.jadohealth.2020.05.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 02/02/2020] [Revised: 05/05/2020] [Accepted: 05/07/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE We developed and validated a measure that assesses the latent construct of sexual and reproductive empowerment among adolescents and young adults. A specific measure for this group is critical because of their unique life stage and circumstances, which often includes frequent changes in sexual partners and involvement from parents in decision-making. METHODS After formative qualitative research, a review of the literature, and cognitive interviews, we developed 95 items representing nine dimensions of sexual and reproductive empowerment. Items were then fielded among a national sample of young people aged 15-24 years, and those who identified as sexually active completed a 3-month follow-up survey. We conducted psychometric analysis and scale validation. RESULTS Exploratory factor analysis on responses from 1,117 participants resulted in the Sexual and Reproductive Empowerment Scale for Adolescents and Young Adults, containing 23 items captured by seven subscales: comfort talking with partner; choice of partners, marriage, and children; parental support; sexual safety; self-love; sense of future; and sexual pleasure. Validation using logistic regression demonstrated that the subscales were consistently associated with sexual and reproductive health information and access to sexual and reproductive health services measured at baseline and moderately associated with the use of desired contraceptive methods at 3-month follow-up. CONCLUSIONS The Sexual and Reproductive Empowerment Scale for Adolescents and Young Adults is a new measure that assesses young people's empowerment regarding sexual and reproductive health. It can be used by researchers, public health practitioners, and clinicians to measure sexual and reproductive empowerment among young people.
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Affiliation(s)
- Ushma D Upadhyay
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, Oakland, California; Center of Expertise in Women's Health, Gender, and Empowerment, University of California Global Health Institute, California.
| | | | - Torsten B Neilands
- School of Medicine, University of California San Francisco, San Francisco, California
| | - Jessica D Gipson
- Department of Community Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California; Center of Expertise in Women's Health, Gender, and Empowerment, University of California Global Health Institute, California
| | - Claire D Brindis
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, Oakland, California; Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California; Adolescent and Young Adult Health National Resource Center, Department of Pediatrics, University of California San Francisco, San Francisco, California
| | | | - Diana Greene Foster
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, Oakland, California
| | - Shari L Dworkin
- School of Nursing and Health Studies, University of Washington Bothell, Bothell, Washington
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Moreno GD, Schmidt LA, Ritchie LD, McCulloch CE, Cabana MD, Brindis CD, Green LW, Altman EA, Patel AI. A cluster-randomized controlled trial of an elementary school drinking water access and promotion intervention: Rationale, study design, and protocol. Contemp Clin Trials 2020; 101:106255. [PMID: 33370616 DOI: 10.1016/j.cct.2020.106255] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 12/16/2020] [Accepted: 12/18/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Promoting water consumption among children in schools is a promising intervention to reduce sugar-sweetened beverage (SSB) intake and achieve healthful weight. To date, no studies in the United States have examined how a school-based water access and promotion intervention affects students' beverage and food intake both in and out of school and weight gain over time. The Water First trial is intended to evaluate these interventions. METHODS Informed by the PRECEDE-PROCEED model and Social Cognitive Theory, the Water First intervention includes: 1) installation of lead-free water stations in cafeterias, physical activity spaces, and high-traffic common areas in lower-income public elementary schools, 2) provision of cups/reusable water bottles for students, and 3) a 6-month healthy beverage education campaign. A five year-long cluster randomized controlled trial of 26 low-income public elementary schools in the San Francisco Bay Area is examining how Water First impacts students' consumption of water, caloric intake from foods and beverages, and BMI z-score and overweight/obesity prevalence, from baseline to 7 months and 15 months after the start of the study. Intervention impact on outcomes will be examined using a difference-in-differences approach with mixed-effects regression accounting for the clustering of students in schools and classrooms. DISCUSSION This paper describes the rationale, study design, and protocol for the Water First study. If the intervention is effective, findings will inform best practices for implementing school water policies, as well as the development of more expansive policies and programs to promote and improve access to drinking water in schools.
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Affiliation(s)
- Gala D Moreno
- School of Medicine, University of California, San Francisco, USA
| | - Laura A Schmidt
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, USA; Department of Anthropology, History and Social Medicine, University of California, San Francisco, USA
| | - Lorrene D Ritchie
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Berkeley, USA
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Michael D Cabana
- Department of Pediatrics, Division of General Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Montefiore, USA
| | - Claire D Brindis
- Philip R. Lee Institute for Health Policy Studies, Bixby Center for Global Reproductive Health, Departments of Pediatrics and Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, USA
| | - Lawrence W Green
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Emily A Altman
- School of Public Health, University of California, Berkeley, USA
| | - Anisha I Patel
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, USA; Department of Pediatrics, School of Medicine, Stanford University, USA.
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Soleimanpour S, Schapiro NA, Faxio A, Brindis CD. A Preliminary Study Examining the Validity of Brief Trauma Screening Tools for Young Adolescents in School-Based Health Centers. J Nurs Meas 2020; 29:53-65. [PMID: 33334845 DOI: 10.1891/jnm-d-19-00043] [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] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE There are very limited brief, validated, open access screening tools for trauma symptoms in adolescent populations. This study aimed to test two brief tools used with adults in primary care settings for use with adolescents. METHODS Youth (n = 77) completed the Posttraumatic Stress Disorder (PTSD) Checklist (PCLC-2), the Primary Care PTSD Screen for Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition (DSM-IV; PC-PTSD), and the PTSD Reaction Index for DSM-5 (reference tool). Sensitivities and specificities were analyzed. RESULTS The PCLC-2 and PC-PTSD demonstrated high sensitivity and specificity with adolescents when using lower cutoff scores than those recommended for adults. CONCLUSIONS The PC-PTSD and PCLC-2 have the potential to be used as brief screens with adolescents. Additional research is needed to further examine their validity with larger, diverse youth samples in primary care and school-based settings.
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Brindis CD, Decker MJ, Gutmann-Gonzalez A, Berglas NF. Perspectives on Adolescent Pregnancy Prevention Strategies in the United States: Looking Back, Looking Forward. Adolesc Health Med Ther 2020; 11:135-145. [PMID: 33117030 PMCID: PMC7567553 DOI: 10.2147/ahmt.s219949] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 09/29/2020] [Indexed: 01/05/2023] Open
Abstract
Attempts to solve the "problem of adolescent pregnancy" have long been a focus of national, state, and local efforts in the United States. This review article summarizes trends and strategies around adolescent pregnancy prevention, provides lessons learned and best practices, and presents ideas for future directions. Over the past decades, a wide variety of policy and programmatic interventions have been implemented - including educational efforts, clinical health services, and community-wide coalitions - accompanied by a growing consensus regarding viable solutions. While notable reductions in adolescent pregnancy and childbearing have occurred across all sociodemographic groups, racial/ethnic, geographic, and socioeconomic disparities persist. Many adolescents who most need sexual health information and services are underserved by current programs and policies. A growing understanding of the role of social determinants of health, the impacts of structural racism, and the need for equity and inclusion must inform the next set of interventions and societal commitments to not only ameliorate the occurrence of unintended adolescent pregnancy but also foster healthy adolescent development. Recommendations for future efforts include improving the content, quality, and sustainability of education programs; actively engaging youth in the design of policies, programs, and clinical services; using technology thoughtfully to improve health literacy; expanding access to services through telehealth and other delivery options; and designing programs and policies that recognize and address structural racism, health equity, and inclusion.
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Affiliation(s)
- Claire D Brindis
- Philip R. Lee Institute for Health Policy Studies, Adolescent and Young Adult Health National Resource Center, Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, CA94118, USA,Correspondence: Claire D Brindis Philip R. Lee Institute for Health Policy Studies, Adolescent and Young Adult Health National Resource Center, Bixby Center for Global Reproductive Health, University of California, San Francisco, 3333 California Street, Suite 265, San Francisco, CA94118, USATel +1 (415) 517-4521 Email
| | - Martha J Decker
- Philip R. Lee Institute for Health Policy Studies, Adolescent and Young Adult Health National Resource Center, Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, CA94118, USA,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA94118, USA
| | - Abigail Gutmann-Gonzalez
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA94118, USA
| | - Nancy F Berglas
- Philip R. Lee Institute for Health Policy Studies, Adolescent and Young Adult Health National Resource Center, Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, CA94118, USA,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA94118, USA,Bixby Center for Global Reproductive Health, University of California, San Francisco, Oakland, CA94612, USA
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Onono MA, Rutherford GW, Bukusi EA, White JS, Goosby E, Brindis CD. Political prioritization and the competing definitions of adolescent pregnancy in Kenya: An application of the Public Arenas Model. PLoS One 2020; 15:e0238136. [PMID: 32925926 PMCID: PMC7489501 DOI: 10.1371/journal.pone.0238136] [Citation(s) in RCA: 2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 08/09/2020] [Indexed: 11/19/2022] Open
Abstract
Background Approximately one in every five adolescent girls in Kenya has either had a live birth or is pregnant with her first child. There is an urgent need to understand the language and symbols used to represent adolescent pregnancy, if the current trend in adolescent pregnancy is to be reversed. Agreement on the definition of a societal problem is an important precursor to a social issue’s political prioritization and priority setting. Methods We apply the Public Arenas Model to appraise the environments, definitions, competition dynamics, principles of selection and current actors involved in problem-solving and prioritizing adolescent pregnancy as a policy issue. Using a focused ethnographic approach, we undertook semi-structured interviews with 14 members of adolescent sexual reproductive health networks at the national level and conducted thematic analysis of the interviews. Findings We found that existing definitions center around adolescent pregnancy as a “disease” that needs prevention and treatment, socially deviant behaviour that requires individual agency, and a national social concern that drains public resources and therefore needs to be regulated. These competing definitions contribute to the rarity of the topic achieving traction within the political agenda and contribute to conflicting solutions, such as lowering the legal age of consenting to sex, while limiting access to contraceptive information and services to minors. Conclusion This paper provides a timely theoretical approach to draw attention to the different competing definitions and subsequent divergent interpretations of the problem of adolescent pregnancy in Kenya. Adolescent reproductive health stakeholders need to be familiar with the existing definitions and deliberately reframe this important social problem for better political prioritization and resource allocation. We recommend a definition of adolescent pregnancy that cuts across different arenas, and leverages already existing dominant and concurrent social and economic issues that are already on the agenda table.
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Affiliation(s)
- Maricianah A. Onono
- Kenya Medical Research Institute, Centre for Microbiology Research, Nairobi, Kenya
- * E-mail:
| | - George W. Rutherford
- Institute of Global Health Sciences, University of California, San Francisco, San Francisco, California, United States of America
| | - Elizabeth A. Bukusi
- Kenya Medical Research Institute, Centre for Microbiology Research, Nairobi, Kenya
| | - Justin S. White
- Institute of Global Health Sciences, University of California, San Francisco, San Francisco, California, United States of America
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California, United States of America
| | - Eric Goosby
- Institute of Global Health Sciences, University of California, San Francisco, San Francisco, California, United States of America
| | - Claire D. Brindis
- Institute of Global Health Sciences, University of California, San Francisco, San Francisco, California, United States of America
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California, United States of America
- Adolescent and Young Adult Health National Resource Centre, San Francisco, California, United States of America
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Cha P, Brindis CD. Early Affordable Care Act Medicaid: Coverage Effects for Low- and Moderate-Income Young Adults. J Adolesc Health 2020; 67:425-431. [PMID: 32631732 DOI: 10.1016/j.jadohealth.2020.05.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 12/04/2019] [Revised: 04/06/2020] [Accepted: 05/06/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of the study was to evaluate the effects of early Medicaid expansions on young adults, who also benefitted from a private dependent coverage expansion. METHODS We used the American Community Survey 2008-2013 to study three early expansion states-California, Connecticut, and Minnesota-using difference-in-differences. Control states are weighted combinations of other states and are similar to expansion states in the prepolicy periods. We analyze young adults and subgroups of women and men. RESULTS Early Medicaid reduced uninsurance and improved public coverage among low- and moderate-income young adults beyond the private dependent coverage expansion, but results differed across states. California, which targeted up to 200 percent of the federal poverty level (FPL), reduced uninsurance 1.3 percentage points (4.2% relative to mean) and increased public insurance by 1.4 percentage points (14.0%). Connecticut, which targeted up to 56 percent of FPL, had no change to uninsurance but a 5.4 percentage point (42.5%) increase in public coverage. Minnesota's programs (up to 75 and 250 percent of FPL) produced a 4.2 percentage point (21.9%) decline in uninsurance for their lowest income group, but no measurable changes for their moderate-income group. Young men benefitted more than women. Their uninsurance declined as much as 6.0 percentage points (25.0%, in Minnesota) and their public coverage increased up to 9.1 percentage points (61.5%, in Connecticut). CONCLUSIONS Medicaid expansion benefits young adults, even those with moderate incomes, and even following a private dependent expansion. Results were larger and concentrated among young men, who historically had little engagement with the program.
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Affiliation(s)
- Paulette Cha
- PhD Program in Health Policy, University of California, Berkeley, Berkeley, California.
| | - Claire D Brindis
- Philip R. Lee Institute for Health Policy Studies and Adolescent and Young Adult Health National Resource Center, University of California, San Francisco, San Francisco, California
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Adams SH, Park MJ, Schaub JP, Brindis CD, Irwin CE. Medical Vulnerability of Young Adults to Severe COVID-19 Illness-Data From the National Health Interview Survey. J Adolesc Health 2020; 67:362-368. [PMID: 32674964 PMCID: PMC7355323 DOI: 10.1016/j.jadohealth.2020.06.025] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 01/05/2023]
Abstract
PURPOSE COVID-19 morbidity and mortality reports in the U.S. have not included findings specific to young adults. The Centers for Disease Control and Prevention provides a list of conditions and associated behaviors, including smoking, conferring vulnerability to severe COVID-19 illness regardless of age. This study examines young adults' medical vulnerability to severe COVID-19 illness, focusing on smoking-related behavior. METHODS A young adult subsample (aged 18-25 years) was developed from the National Health Interview Survey, a nationally representative data set, pooling years 2016-2018. The medical vulnerability measure (yes vs. no) was developed, guided by the Centers for Disease Control and Prevention medical indicators. The estimates of medical vulnerability were developed for the full sample, the nonsmoking sample, and the individual risk indicators. Logistic regressions were conducted to examine differences by sex, race/ethnicity, income, and insurance. RESULTS Medical vulnerability was 32% for the full sample and half that (16%) for the nonsmoking sample. Patterns and significance of some subgroup differences differed between the full and the nonsmoking sample. Male vulnerability was (33%) higher than female (30%; 95% CI: .7-.9) in the full sample, but lower in nonsmokers: male (14%) versus female (19%; 95% CI: 1.2-1.7). The white subgroup had higher vulnerability than Hispanic and Asian subgroups in both samples-full sample: white (31%) versus Hispanic (24%; 95% CI: .6-.9) and Asian (18%; 95% CI: .4-.5); nonsmokers: white (17%) versus Hispanic (13%; 95% CI: .06-.9) and Asian (10%; 95% CI: .3-.8). CONCLUSIONS Notably, lower young adult medical vulnerability within nonsmokers versus the full sample underscores the importance of smoking prevention and mitigation.
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Affiliation(s)
- Sally H. Adams
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, California,Address correspondence to: Sally H. Adams, R.N., Ph.D., University of California, San Francisco, 3333 California Street, Suite 245, San Francisco, CA 94143.
| | - M. Jane Park
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, California
| | - Jason P. Schaub
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, California
| | - Claire D. Brindis
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, California,Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California
| | - Charles E. Irwin
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, California
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Kassabian S, Fewer S, Yamey G, Brindis CD. Building a global policy agenda to prioritize preterm birth: A qualitative analysis on factors shaping global health policymaking. Gates Open Res 2020; 4:65. [PMID: 33117963 PMCID: PMC7578407 DOI: 10.12688/gatesopenres.13098.1] [Citation(s) in RCA: 4] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2020] [Indexed: 11/29/2022] Open
Abstract
Background: Preterm birth, defined as infants born before 37 weeks of gestation, is the largest contributor to child mortality. Despite new evidence highlighting the global burden of prematurity, policymakers have failed to adequately prioritize preterm birth despite the magnitude of its health impacts. Given current levels of political attention and investment, it is unlikely that the global community will be adequately mobilized to meet the 2012 Born Too Soon report goal of reducing the preterm birth rate by 50% by 2025. Methods: This study adapts the Shiffman and Smith framework for political priority to examine four components contributing to policy action in global health: actor power, ideas, political context, and issue characteristics. We conducted key informant interviews with 18 experts in prematurity and reproductive, maternal, newborn, and child health (RMNCH) and reviewed key literature on preterm birth. We aimed to identify the factors that shape the global political priority of preterm birth and to describe policy opportunities to increase its priority moving forward. Results: The global preterm birth community (academic researchers, multilateral organizations, government agencies, and civil society organizations) lacks evidence about the causes of and solutions to preterm birth; and country-level data quality is poor with gaps in the understanding required for implementing effective interventions. Limited funding compounds these challenges, creating divisions among experts on what policy actions to recommend. These factors contribute to the lack of priority and underrepresentation of preterm birth within the larger RMNCH agenda. Conclusion: Increasing the political priority of prematurity is essential to reduce preventable newborn and child mortality, a key target of the 2030 Sustainable Development Goal for health (target 3.2). This study identifies three policy recommendations for the preterm birth community: address data and evidence gaps, clarify and invest in viable solutions, and bring visibility to prematurity within the larger RMNCH agendas.
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Affiliation(s)
- Sara Kassabian
- Institute of Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Sara Fewer
- Evidence to Policy Initiative, University of California San Francisco, San Francisco, CA, USA
| | - Gavin Yamey
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Claire D. Brindis
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA
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Kreger M, Sargent Cairoli K, Brindis CD. An Underpinning of School Inequities: Asthma Absences and Lost Revenue in California Schools. J Sch Health 2020; 90:200-211. [PMID: 31957039 DOI: 10.1111/josh.12869] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 01/25/2019] [Accepted: 01/30/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Asthma is epidemic in many locations in the United States. Asthma exacerbations pose serious health and education risks for students through school absences, school dropout, and introduction to the juvenile justice system. Accurate school district-level asthma data, currently in short supply, would enable early interventions that focus on specific geographic areas and racial and ethnic subgroups that have higher asthma prevalence. METHODS To support the development of better local level data systems, we used two California student databases, as well as state education and financial databases, to develop two models to estimate school absences and to extrapolate their economic impact in lost school revenue. RESULTS Analysis demonstrated subpopulations that are appropriate for early intervention: African American elementary school boys have 9.4 average absences per year, higher than other primary racial and ethnic groups. Students who miss ≥3 school days due to asthma account for $26 million of lost revenue. CONCLUSIONS Accurate local level asthma data can identify subpopulations of students for whom environmental and treatment programs can be employed to reduce asthma absences and other related outcomes, and to reduce currently lost school revenues. Such programs also may diminish other asthma-related school inequities.
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Affiliation(s)
- Mary Kreger
- Science and Health Education Partnership, Department of Biochemistry, University of California, San Francisco, 3533 21st Street, San Francisco, CA, 94114
| | - Katherine Sargent Cairoli
- Science and Health Education Partnership, Department of Biochemistry, University of California, San Francisco, 3533 21st Street, San Francisco, CA, 94114
| | - Claire D Brindis
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, 3333 California Street, San Francisco, CA, 94118
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Dickson E, Parshall M, Brindis CD. Isolated Voices: Perspectives of Teachers, School Nurses, and Administrators Regarding Implementation of Sexual Health Education Policy. J Sch Health 2020; 90:88-98. [PMID: 31813167 PMCID: PMC7004136 DOI: 10.1111/josh.12853] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 02/12/2019] [Accepted: 04/28/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Comprehensive sexual health education (SHE) reduces risky sexual behavior and increases protective behavior in adolescents. It is important to understand how professionals responsible for implementing SHE policy interpret state and local policy and what influences their commitment to formal SHE policy implementation. METHODS This descriptive study explored content and delivery of SHE policy in a rural, southwestern state with high levels of poverty, unintended adolescent pregnancy, and sexually transmitted infections. The social ecological model (SEM) was used to better understand levels of influence on the implementation of SHE policy. RESULTS We conducted telephone surveys with 38 teachers, 63 nurses, and 21 administrators in public secondary schools. There was substantial local variability in the scope and content of SHE curricula. Respondents identified significant barriers to the delivery of SHE content and minimal evaluation of whether educational objectives were met. Based on participant responses, community and organizational SEM levels had the greatest influence on SHE policy implementation, although examples of all SEM levels were identified. CONCLUSIONS Given perceived challenges regarding subject matter, successful SHE implementation at the local level requires committed stakeholders working in concert at the school and community levels, backed by strong policy commitment at the state level.
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Affiliation(s)
- Elizabeth Dickson
- University of New Mexico, College of Nursing, MSC07 4380 Box 9, 1 University of New MexicoAlbuquerqueNM87131
| | - Mark Parshall
- University of New Mexico, College of Nursing, MSC07 4380 Box 9, 1 University of New MexicoAlbuquerqueNM87131
| | - Claire D. Brindis
- Department of Pediatrics, Division of Adolescent Medicine, University of California San Francisco, Philip R. Lee Institute for Health Policy Studies, Adolescent and Young Adult Health National Resource Center, 3333 California StreetSan FranciscoCA94118
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Raymond-Flesch M, Lucia L, Jacobs K, Brindis CD. Improving Medicaid Access in Times of Health Policy Change: Solutions from Focus Groups with Frontline Enrollment Workers. J Health Care Poor Underserved 2019; 30:280-296. [PMID: 30827983 DOI: 10.1353/hpu.2019.0021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Enrollment navigators and government-employed Medicaid workers were an important element in the Affordable Care Act's (ACA) initial enrollment success. The Centers for Medicare and Medicaid Services eliminated 41% of funding for 2017 navigator programs and 90% of funding for outreach, arguing less investment was needed. Given that many remain uninsured, it is critical to identify effective enrollment practices. This study characterizes barriers and enrollment strategies from the perspective of California's Medicaid government and community-based enrollment workers (n=101 in eight focus groups). Participants identified a need for communication with policymakers, the state exchange, and each other regarding changing enrollment processes. Solutions include increased contact between enrollment workers to share strategies and policy updates regarding application processing, uniform policy interpretation, and details of ACA-related immigration law. Given efforts to weaken the ACA, it is critical to engage frontline workers in problem solving to streamline enrollment strategies, particularly for vulnerable populations.
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Bonnie RJ, Backes EP, Alegria M, Diaz A, Brindis CD. Fulfilling the Promise of Adolescence: Realizing Opportunity for All Youth. J Adolesc Health 2019; 65:440-442. [PMID: 31439468 DOI: 10.1016/j.jadohealth.2019.07.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 07/25/2019] [Indexed: 10/26/2022]
Affiliation(s)
| | - Emily P Backes
- National Academies of Sciences, Engineering, and Medicine, Washington, DC
| | | | - Angela Diaz
- Department of Pediatrics, Icahn School of Medicine at Mt. Sinai, New York, New York; Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mt. Sinai, New York, New York
| | - Claire D Brindis
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California.
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Dickson E, Brindis CD. The Double Bind of School Nurses and Policy Implementation: Intersecting the Street-Level Bureaucracy Framework and Teaching Sexual Health Education. J Sch Nurs 2019; 37:280-291. [PMID: 31438767 DOI: 10.1177/1059840519868764] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 12/25/2022] Open
Abstract
As described in the Framework for 21st Century School Nursing Practice, school nurses bridge the realities of health and education policy within the school community every day. This role is inclusive of helping teach sexual health education (SHE) to students. We were interested in characterizing how school nurses navigate requirements of health education policy to provide their students with the SHE content that they need. Using data from a larger study, we organized a subset of school nurse data within the street-level bureaucracy framework to better understand the many challenges school nurses face in implementing SHE policy. School nurses' involvement in SHE policy implementation was congruent with characteristics of the framework. This included using their professional discretion to manage dilemmas, working with inadequate resources, unclear policy expectations, lack of support, and ambiguous policy goals. Trusted relationships with teachers and students helped school nurses with their SHE policy implementation responsibilities.
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Affiliation(s)
| | - Claire D Brindis
- Division of Adolescent Medicine, Department of Pediatrics, Adolescent and Young Adult Health National Resource Center, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA
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40
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Laguna MC, Hecht AA, Ponce J, Jue T, Brindis CD, Patel AI. Teachers as Healthy Beverage Role Models: Relationship of Student and Teacher Beverage Choices in Elementary Schools. J Community Health 2019; 45:121-127. [PMID: 31407126 DOI: 10.1007/s10900-019-00717-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 07/17/2019] [Accepted: 07/31/2019] [Indexed: 01/17/2023]
Abstract
Schools are a key setting for curbing student intake of sugar-sweetened beverages (SSBs). While studies suggest that restrictions on SSBs, increased access to healthier beverages, and education about the importance of drinking water instead of SSBs can promote healthier beverage patterns among students, there is little known about the impact that teachers' own beverage choices can have on those of their students. Data were drawn from cross-sectional surveys administered as part of a larger evaluation of a drinking water access and promotion intervention in public elementary schools in the San Francisco Bay Area region of California. Descriptive statistics were used to examine teacher (n = 56) and student (n = 1176) self-reported beverage consumption at school. Mixed-effects logistic regression was used to examine associations between teacher and student beverage intake adjusting for clustering of students by teacher. Teachers were also surveyed via open-ended questions about strategies to increase student water consumption at school. Nearly all teachers reported drinking water during the school day (95%), often in front of students. Teacher SSB intake was rare (9%). Students whose teachers drank water in front of their classes were significantly more likely to report drinking water during the school day. Teachers tend to select healthy beverages at work and may serve as role models to encourage student consumption of water instead of SSBs.
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Affiliation(s)
- Meredith C Laguna
- Division of General Pediatrics, University of California San Francisco, 2330 Post St. #320, San Francisco, CA, 94143, USA.
| | - Amelie A Hecht
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Julian Ponce
- University of California Berkeley, Berkeley, USA
| | - Tyson Jue
- FIRST 5 Santa Clara County, San Jose, USA
| | - Claire D Brindis
- Institute for Health Policy Studies, University of California San Francisco, San Francisco, USA
| | - Anisha I Patel
- Division of General Pediatrics, Stanford University, Stanford, USA
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41
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Adams SH, Park MJ, Twietmeyer L, Brindis CD, Irwin CE. Young Adult Preventive Healthcare: Changes in Receipt of Care Pre- to Post-Affordable Care Act. J Adolesc Health 2019; 64:763-769. [PMID: 30850314 DOI: 10.1016/j.jadohealth.2018.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 08/23/2018] [Revised: 11/22/2018] [Accepted: 12/04/2018] [Indexed: 12/01/2022]
Abstract
PURPOSE Young adults have unique health and health care needs. Although morbidity and mortality stem largely from preventable factors, they lack a structured set of preventive care guidelines. The Affordable Care Act (ACA), enacted in 2010, increased young adult insurance coverage, prohibited copayments for preventive visits among privately insured and for many preventive services. The objectives were to evaluate pre- to post-ACA changes in young adults' past-year well visits and, among those using a past-year health care visit, the receipt of preventive services. METHODS We used pooled Medical Expenditure Panel Survey data, comparing pre-ACA (2007-2009, N = 10,294) to post-ACA (2014-2016, N = 10,567) young adults aged 18-25 years. Bivariable and multivariable stratified logistic regression, adjusting for sociodemographic covariates, were conducted to determine differences in well visits and in preventive services among past-year health care utilizers: blood pressure and cholesterol checks, influenza immunization, and all three received. RESULTS Past-year well visits increased from pre-ACA (28%) to post-ACA (32%), p < .001. Increases were noted for most demographic subgroups with greatest increases among males, Asian, and highest income subgroups. Larger pre- to post-ACA increases were found for most of the preventive services, p < .05, including the receipt of all three services (7% vs. 16%), p < .001, among past-year health care utilizers. CONCLUSION Following ACA implementation, young adults experienced modest increases in well visit rates and larger increases in most preventive services received. Overall rates of both remain low. Building on these improvements requires concerted efforts that account for young adults' unique combination of health care issues and challenges in navigating an adult health care system.
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Affiliation(s)
- Sally H Adams
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UCSF Benioff Children's Hospital, University of California, San Francisco, San Francisco, California.
| | - M Jane Park
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UCSF Benioff Children's Hospital, University of California, San Francisco, San Francisco, California
| | - Lauren Twietmeyer
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UCSF Benioff Children's Hospital, University of California, San Francisco, San Francisco, California
| | - Claire D Brindis
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UCSF Benioff Children's Hospital, University of California, San Francisco, San Francisco, California; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California
| | - Charles E Irwin
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UCSF Benioff Children's Hospital, University of California, San Francisco, San Francisco, California
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Schapiro NA, Green EK, Kaller S, Brindis CD, Rodriguez A, Alkebulan-Abakah M, Chen JL. Impact on Healthy Behaviors of Group Obesity Management Visits in Middle School Health Centers. J Sch Nurs 2019; 37:87-98. [PMID: 30983480 DOI: 10.1177/1059840519842226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This mixed-methods community-based participatory pilot study examined the feasibility and preliminary efficacy of group obesity management visits offered through school-based health centers. The study was implemented through an academic-community partnership in three school health centers serving primarily Latinx and African American youth. Participants (n = 71) completed pre- and post-surveys about intention to change diet and exercise habits, knowledge and self-efficacy related to healthy eating, and social support. Focus groups were conducted after the intervention and 18 months later. Group visits were feasible and highly valued by study participants. Quantitative results showed a significant decrease in soda consumption, increased support from classmates, and an increased number of exercise days. In focus groups, youth endorsed cooking, tasting, and shopping activities, noted the importance of family involvement in behavior change, and stated that stress reduction mindfulness exercises helped to change eating habits. Implications for school-based health care and school nursing are discussed.
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Affiliation(s)
- Naomi A Schapiro
- School of Nursing, 8785University of California, San Francisco, CA, USA
| | - Emily K Green
- School of Nursing, University of California, Los Angeles, CA, USA
| | - Shelly Kaller
- Advancing New Standards in Reproductive Health, 8785University of California, San Francisco, San Francisco, CA, USA
| | - Claire D Brindis
- Philip R. Lee Institute for Health Policy Studies, 8785University of California, San Francisco, San Francisco, CA, USA
- Adolescent and Young Adult Health National Resource Center, 8785University of California, San Francisco, CA, USA
| | | | | | - Jyu-Lin Chen
- School of Nursing, 8785University of California, San Francisco, CA, USA
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Mendelson T, Mmari K, Blum RW, Catalano RF, Brindis CD. Opportunity Youth: Insights and Opportunities for a Public Health Approach to Reengage Disconnected Teenagers and Young Adults. Public Health Rep 2019; 133:54S-64S. [PMID: 30426873 PMCID: PMC6243446 DOI: 10.1177/0033354918799344] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Approximately 1 in 9 teenagers and young adults aged 16-24 in the United States is currently disconnected from school and employment. These disconnected young people (ie, opportunity youth) are not only at high risk for long-term emotional, behavioral, and health problems, but they also represent a loss of human capital, with high social and economic costs. In this article, we offer a public health perspective on opportunity youth by describing their distribution in the population and consequences of their disconnection; proposing a conceptual model of the issue based on epidemiological principles, life course development concepts, and ecological theory; and recommending multisector strategies for preventing disconnection of young people and reengaging opportunity youth. A public health approach to the problem of opportunity youth would involve developing and investing in youth monitoring data systems that can be coordinated across multiple sectors, consolidating both the delivery and funding of services for opportunity youth, developing policies and programs that encourage engagement of young people, and fostering systematic approaches to the testing and scaling up of preventive and reengagement interventions.
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Affiliation(s)
- Tamar Mendelson
- 1 Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kristin Mmari
- 2 Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Robert W Blum
- 2 Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Claire D Brindis
- 4 Adolescent and Young Adult Health National Research Center, University of California, San Francisco, School of Medicine, San Francisco, CA, USA
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Tebb KP, Pica G, Twietmeyer L, Diaz A, Brindis CD. Innovative Approaches to Address Social Determinants of Health Among Adolescents and Young Adults. Health Equity 2018; 2:321-328. [PMID: 30450488 PMCID: PMC6238651 DOI: 10.1089/heq.2018.0011] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: Social determinants are the leading causes of health disparities. Yet health care systems have not systemically addressed social determinants of health as it pertains to adolescents and young adults (AYAs), among other populations in need. This study identified promising innovative programs across the United States. Methods: Thirteen representatives from 10 programs completed a 45-min telephone interview. Transcripts were reviewed and analyzed to identify cross-cutting themes. Results: Strategies included increasing access to quality, comprehensive and confidential health services, addressing the holistic needs of AYAs, collaborations across the health care delivery systems and other community services, and leveraging technology. Conclusion: This study showcased innovative approaches to inform future efforts.
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Affiliation(s)
- Kathleen P Tebb
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Benioff Children's Hospital and the Adolescent and Young Adult Health National Resource Center, University of California, San Francisco, California
| | | | - Lauren Twietmeyer
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Benioff Children's Hospital and the Adolescent and Young Adult Health National Resource Center, University of California, San Francisco, California
| | - Angela Diaz
- Icahn School of Medicine at Mount Sinai and Mount Sinai Adolescent Health Center, New York, New York
| | - Claire D Brindis
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Benioff Children's Hospital and the Adolescent and Young Adult Health National Resource Center, University of California, San Francisco, California.,Philip R. Lee Institute for Health Policy Studies and the Adolescent and Young Adult Health National Resource Center, University of California, San Francisco, California
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Wallace SP, Young MEDT, Rodríguez MA, Brindis CD. A social determinants framework identifying state-level immigrant policies and their influence on health. SSM Popul Health 2018; 7:016-16. [PMID: 30581960 PMCID: PMC6293030 DOI: 10.1016/j.ssmph.2018.10.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [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] [Received: 02/02/2018] [Revised: 10/30/2018] [Accepted: 10/31/2018] [Indexed: 12/17/2022] Open
Abstract
Background Many conceptual frameworks that touch on immigration and health have been published over the past several years. Most discuss broad social trends or specific immigrant policies, but few address how the policy environment affects the context of settlement and incorporation. Research on the social determinants of health shows how policies across multiple sectors have an impact on health status and health services, but has not yet identified the policies most important for immigrants. Understanding the range and content of state-level policies that impact immigrant populations can focus health in all policies initiatives as well as contextualize future research on immigrant health. Methods Our framework identifies state-level policies across five different domains that impact the health of immigrants and that vary across states, especially for those without legal status. Our scan shows that immigrants are exposed to different contexts, ranging from relatively inclusive to highly exclusive; a number of states have mixed trends that are more inclusive in some areas, but exclusive in others. Finally, we examine how the relative inclusiveness of state policies are associated with state-level demographic and political characteristics. Results Contrary to the image that exclusive policies are a reaction to large immigrant populations that may compete for jobs and cultural space, we find that the higher the proportion of foreign born and Hispanics in the state, the more inclusive the set of policies; while the higher the proportion of Republican voters, the less inclusive. Conclusions Variation across immigrant policies is much larger than the variation in state demographic and political characteristics, suggesting that state-level policies need to be included as a possible independent, contextual effect, when assessing immigrant health outcomes. This policy framework can be particularly useful in bridging our understanding of how large macro processes are connected to the daily lives and health of immigrants. While federal immigration law sets the policy stage, state immigrant policies create differential access to rights and opportunities within a wide range of social institutions based on an individual’s citizenship and legal status. State immigrant policies, across a range of sectors, create the context of reception and settlement that are determinants of immigrant health by extending rights and protections or by reinforcing restrictive federal policies. State immigrant policy contexts vary considerable across the United States and are subject to unique dynamics, independent of other state factors.
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Affiliation(s)
- Steven P Wallace
- Department of Community Health Sciences, UCLA Center for Health Policy Research, Fielding School of Public Health, University of California, Los Angeles, 10960 Wilshire Blvd, #1550, Los Angeles, CA, 90024, USA
| | - Maria-Elena De Trinidad Young
- Department of Community Health Sciences, UCLA Center for Health Policy Research, Fielding School of Public Health, University of California, Los Angeles, 10960 Wilshire Blvd, #1550, Los Angeles, CA, 90024, USA
| | - Michael A Rodríguez
- Department of Family Medicine, UCLA Blum Center on Poverty and Health in Latin America, 10880 Wilshire Blvd, Suite 1800, Los Angeles, CA 90024, USA
| | - Claire D Brindis
- Adolescent and Young Adult Health National Resource Center, University of California, San Francisco, 3333 California St., Suite 265, San Francisco, CA 94143-0936, USA.,Philip R. Lee Institute for Health Policy Studies, Adolescent and Young Adult Health National Resource Center, University of California, San Francisco, 3333 California St., Suite 265, San Francisco, CA 94143-0936, USA
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Affiliation(s)
- Claire D Brindis
- Philip R. Lee Institute for Health Policy Studies, and the Adolescent and Young Adult Health National Resource Center, University of California,San Francisco, San Francisco, California.
| | - Amy Houtrow
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Malekinejad M, Horvath H, Snyder H, Brindis CD. The discordance between evidence and health policy in the United States: the science of translational research and the critical role of diverse stakeholders. Health Res Policy Syst 2018; 16:81. [PMID: 30115085 PMCID: PMC6097290 DOI: 10.1186/s12961-018-0336-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 11/16/2017] [Accepted: 06/06/2018] [Indexed: 12/29/2022] Open
Abstract
Background There is often a discordance between health research evidence and public health policies implemented by the United States federal government. In the process of developing health policy, discordance can arise through subjective and objective factors that are unrelated to the value of the evidence itself, and can inhibit the use of research evidence. We explore two common types of discordance through four illustrative examples and then propose a potential means of addressing discordance. Discussion In Discordance 1, public health authorities make recommendations for policy action, yet these are not based on high quality, rigorously synthesised research evidence. In Discordance 2, evidence-based public health recommendations are ignored or discounted in developing United States federal government policy. Both types could lead to serious risks of public health and clinical patient harms. We suggest that, to mitigate risks associated with these discordances, public health practitioners, health policy-makers, health advocates and other key stakeholders should take the opportunity to learn or expand their knowledge regarding current research methods, as well as improve their skills for appropriately considering the strengths and limitations of research evidence. This could help stakeholders to adopt a more nuanced approach to developing health policy. Stakeholders should also have a more insightful contextual awareness of these discordances and understand their potential harms. In Discordance 1, public health organisations and authorities need to acknowledge their own historical roles in making public health recommendations with insufficient evidence for improving health outcomes. In Discordance 2, policy-makers should recognise the larger impact of their decision-making based on minimal or flawed evidence, including the potential for poor health outcomes at population level and the waste of huge sums. In both types of discordance, stakeholders need to consider the impact of their own unconscious biases in championing evidence that may not be valid or conclusive. Conclusion Public health policy needs to provide evidence-based solutions to public health problems, but this is not always done. We discuss some of the factors inhibiting evidence-based decision-making in United States federal government public health policy and suggest ways these could be addressed.
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Affiliation(s)
- Mohsen Malekinejad
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, 3333 California Street, Suite 265, San Francisco, CA, 94118, United States of America. .,Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States of America. .,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States of America.
| | - Hacsi Horvath
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, 3333 California Street, Suite 265, San Francisco, CA, 94118, United States of America.,Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States of America.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States of America
| | - Harry Snyder
- Advocacy Leader in Residence, University of California School of Public Health, Berkeley, CA, United States of America
| | - Claire D Brindis
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, 3333 California Street, Suite 265, San Francisco, CA, 94118, United States of America.,Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States of America.,Adolescent and Young Adult Health National Resource Center, University of California, San Francisco, San Francisco, CA, United States of America
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Adams SH, Park MJ, Twietmeyer L, Brindis CD, Irwin CE. Increasing Delivery of Preventive Services to Adolescents and Young Adults: Does the Preventive Visit Help? J Adolesc Health 2018; 63:166-171. [PMID: 29929838 DOI: 10.1016/j.jadohealth.2018.03.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 11/10/2017] [Revised: 03/06/2018] [Accepted: 03/06/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE Despite decades of emphasizing the delivery of adolescent preventive care visits and evidence that many preventive services reduce risk, little evidence links preventive visits to increased preventive service delivery. This study examined whether a preventive healthcare visit versus any nonpreventive healthcare visit was associated with higher rates of adolescent and young adult preventive services. METHODS Analyzed Medical Expenditure Panel Survey data (2013-2015) to determine whether those with a preventive versus nonpreventive healthcare visit had higher rates of past-year preventive services receipt; adolescents (N = 8,474, ages 10-17) and young adults (N = 5,732, ages 18-25). Bivariable and multivariable analyses adjusting for personal/sociodemographic covariates tested for differences in preventive services rates between preventive versus nonpreventive care groups. Adolescent services were blood pressure, height and weight measured, and all three measured; and guidance given regarding healthy eating, physical activity, seatbelts and helmets, secondhand smoke, dental care, all six topics received, and time alone with provider. Young adult services were blood pressure and cholesterol checked, received influenza immunization, and all three services received. RESULTS All preventive services rates were significantly higher in those attending preventive visits versus those with nonpreventive visits. Adolescent services increase ranged from 7% to 19% and young adults increase from 9% to 14% (all bivariable and multivariable analyses, p < .001). However, most rates were low overall. CONCLUSIONS Higher rates of preventive services associated with preventive visits support its clinical care value. However, low preventive services rates overall highlight necessary increased efforts to promote preventive care and improve the provider delivery of prevention for both age groups.
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Affiliation(s)
- Sally H Adams
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, California
| | - M Jane Park
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, California
| | - Lauren Twietmeyer
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, California.
| | - Claire D Brindis
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, California; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California
| | - Charles E Irwin
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, California
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Abstract
BACKGROUND Over the last quarter century, there has been an emergence of evidence-based research directed toward the development, implementation, and assessment of youth-friendly health services (YFHS) to improve the delivery of sexual and reproductive health services for young people. Despite these research efforts, evidence supporting the effectiveness of YFHS is limited, which may be attributed to a lack of consensus on how to define and measure youth-friendliness to track progress and evaluate outcomes. The purpose of this systematic review is to assess how youth-friendly sexual and reproductive health services are measured worldwide. METHODS We conducted a systematic review of studies measuring youth-friendly sexual and reproductive health services at health facilities published between January 2000 and June 2015 using PubMed, Web of Science, and POPLINE databases. Additional studies were identified by reviewing references of selected articles. Studies were screened to identify measurements and indicators that have been used to measure YFHS. RESULTS Our review identified 20 studies from an initial search of more than 11,000 records, including six from high-income countries and 14 from low-and middle-income countries. The review identified 115 indicators used for measuring youth-friendly sexual and reproductive health services. Our review found a lack of consistency in the tools and indicators used to measure YFHS. The three most frequently assessed domains were accessibility, staff characteristics and competency, and confidentiality and privacy. The majority of the indicators were not specific to young people's needs and often reflected basic standards of care. CONCLUSIONS This review shows the need for standardization and prioritization of indicators for the evaluation of YFHS. The results can be used to identify a core set of indicators that can be incorporated into a framework for assessing youth-friendly sexual and reproductive health services. There is a need to further distinguish between those variables that may have greatest impact on the use of services by young people, such as respect and privacy, those that impact the quality of services offered, and those that have limited relevance. Conducting more rigorous studies using a refined set of indicators is critical to measure and compare the impact and effectiveness of YFHS efforts.
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Affiliation(s)
- Amanda Mazur
- Philip R. Lee Institute for Health Policy Studies and Bixby Center for Global Reproductive Health, University of California, San Francisco, 3333 California Street, Suite 265, San Francisco, CA 94143-0936 USA
| | - Claire D. Brindis
- Philip R. Lee Institute for Health Policy Studies and Bixby Center for Global Reproductive Health, University of California, San Francisco, 3333 California Street, Suite 265, San Francisco, CA 94143-0936 USA
- Adolescent and Young Adult Health National Resource Center, University of California, San Francisco, 3333 California Street, Suite 245, San Francisco, CA 94143-0503 USA
| | - Martha J. Decker
- Philip R. Lee Institute for Health Policy Studies and Bixby Center for Global Reproductive Health, University of California, San Francisco, 3333 California Street, Suite 265, San Francisco, CA 94143-0936 USA
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Ralph LJ, King E, Belusa E, Foster DG, Brindis CD, Biggs MA. The Impact of a Parental Notification Requirement on Illinois Minors' Access to and Decision-Making Around Abortion. J Adolesc Health 2018; 62:281-287. [PMID: 29248391 DOI: 10.1016/j.jadohealth.2017.09.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 06/02/2017] [Revised: 08/15/2017] [Accepted: 09/18/2017] [Indexed: 12/22/2022]
Abstract
PURPOSE This study aims to examine the impact of a parental notification (PN) requirement on the frequency, timing, and out-of-state travel of minors seeking abortion, as well as changes in who minors involve in their decision, support received, and decision certainty. METHODS We analyzed administrative and medical records of 1,577 women obtaining an abortion before and after implementation of a PN requirement at one Illinois facility. Using multivariate regression within a difference-in-differences framework, we quantified changes in the number and timing of women seeking care, frequency of parental awareness and support, travel from out-of-state, decision certainty, and anticipated coping among minors 17 years and below compared with young adults (YAs) aged 18-20 years. RESULTS A smaller proportion of abortions to women ages 20 years and under post-law were among minors (39%-33%, p = .017). Compared with YAs, minors experienced a larger increase in parental awareness (71%-93% [minors] vs. 53%-58% [YAs], p < .000]; however, parents' support for the decision was unchanged. The proportion of minors certain of their decision went from 77% pre-law to 71% post-law (p = .099) compared with 82% pre- and post-law among YAs (p = .798). Compared with YAs, a larger proportion of minors obtained second trimester care post-law if coming from another state (21%-31% [minors] vs. 23%-16% [YAs], p = .022). CONCLUSIONS Illinois' PN requirement was associated with a decrease in the number of abortions among minors, delayed care for those from out-of-state, increased parental awareness of the pregnancy, and no change in parents' support.
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Affiliation(s)
- Lauren J Ralph
- Advancing New Standards in Reproductive Health (ANSIRH), Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland, California.
| | - Erin King
- Hope Clinic for Women, Ltd, Granite City, Illinois
| | - Elise Belusa
- Advancing New Standards in Reproductive Health (ANSIRH), Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland, California
| | - Diana Greene Foster
- Advancing New Standards in Reproductive Health (ANSIRH), Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland, California
| | - Claire D Brindis
- Philip R. Lee Institute for Health Policy Studies, Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, California
| | - M Antonia Biggs
- Advancing New Standards in Reproductive Health (ANSIRH), Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland, California
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