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Swietek K, Jones KA, Bettger JP, French A, Maslow G, Norman KS, Lake AD, Carvalho M, Cholera R, Freed SS, Tchuisseu YP, Repka S, Whitaker RG. What Explains Inequalities in Telehealth Utilization Among North Carolina Medicaid Beneficiaries? Telemed J E Health 2024. [PMID: 38728091 DOI: 10.1089/tmj.2023.0563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024] Open
Abstract
Background: Increased availability of telehealth can improve access to health care. However, there is evidence of persistent disparities in telehealth usage, as well as among people from minoritized racial and ethnic groups and rural residents. The objective of our work was to explore the degree to which disparities in telehealth use for behavioral health (BH) and musculoskeletal (MSK) related services during the COVID-19 pandemic are explained by observed beneficiary- and area-level characteristics. Methods: Using North Carolina Medicaid claims data of Medicaid beneficiaries with BH or MSK conditions, we apply nonlinear regression-based decomposition analysis-based models developed by Kitagawa, Oaxaca, and Blinder to determine which observed variables are associated with racial, ethnic, and rural inequalities in telehealth usage. Results: In the BH cohort, we found statistically significant differences in telehealth usage by race in the adult population, and by race, Hispanic ethnicity, and rurality in the pediatric population. In the MSK cohort, we found significant inequities by Hispanic ethnicity and rurality among adults, and by race and rurality among children. Inequalities in telehealth use between groups were small, ranging from 0.7 percentage points between urban and rural adults with MSK conditions to 3.8 percentage points between white adults and people of color among those with BH conditions. Overall, we found that racial and ethnic inequalities in telehealth use are not well explained by the observed variables in our data. Rural disparities in telehealth use are better explained by observed variables, particularly area-level broadband internet use. Conclusions: For inequalities between rural and urban residents, our analysis provides observational evidence that infrastructure such as broadband internet access is an important driver of differences in telehealth use. For racial and ethnic inequalities, the pathways may be more complex and difficult to measure, particularly when relying on administrative data sources in place of more detailed data on individual-level socioeconomic factors.
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Affiliation(s)
- Karen Swietek
- Health Care Evaluation Department, NORC at the University of Chicago, Cambridge, Massachusetts, USA
| | - Kelley A Jones
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Janet Prvu Bettger
- Duke-Margolis Institute for Health Policy, Duke University, Durham, North Carolina, USA
| | - Alexis French
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Gary Maslow
- Duke-Margolis Institute for Health Policy, Duke University, Durham, North Carolina, USA
- Department of Psychiatry, Duke University School of Medicine, Durham, North Carolina, USA
| | - Katherine S Norman
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Ashley D Lake
- Duke Physical Therapy Sports Medicine at the Center for Living, Duke Health, Durham, North Carolina, USA
| | - Marissa Carvalho
- Department of Physical Therapy and Occupational Therapy, Duke University Health System, Durham, North Carolina, USA
| | - Rushina Cholera
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Duke-Margolis Institute for Health Policy, Duke University, Durham, North Carolina, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Salama S Freed
- Department of Health Policy and Management, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA
| | | | - Samantha Repka
- Duke-Margolis Institute for Health Policy, Duke University, Durham, North Carolina, USA
| | - Rebecca G Whitaker
- Duke-Margolis Institute for Health Policy, Duke University, Durham, North Carolina, USA
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Anderson JC, Boakye MD, Feinstein Z, Miller-Walfish S, Jones KA, Chugani CD, Schmulevich A, Jackson R, Miller E. College students' experiences of sexual violence and reasons for seeking care in campus health and counseling centers. J Am Coll Health 2024; 72:753-760. [PMID: 35380934 PMCID: PMC9532461 DOI: 10.1080/07448481.2022.2057189] [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] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 07/01/2021] [Accepted: 03/20/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Examine associations between care seeking reasons in college health and counseling centers and sexual violence (SV). PARTICIPANTS College students (n = 2,084 baseline, n = 1,170 one-year follow up) participating in a cluster randomized controlled trial of an SV reduction intervention on 28 campuses. METHODS Computer-based survey data gathered during students' clinic visit and one-year follow up. RESULTS Despite high prevalence of SV, students almost never sought care specifically for SV (0.5% of reported visits). Gender differences emerged for reasons students sought care generally, but were not associated with differences in care seeking among those who experienced SV. At baseline and one-year, students who reported SV were more likely to state mental or sexual and reproductive health as their reason for care seeking. CONCLUSION Many students seeking care have experienced SV yet present with other health needs. Providers need to recognize this and have a low threshold for providing SV resources routinely. Supplemental data for this article can be accessed online at https://doi.org/10.1080/07448481.2022.2057189.
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Affiliation(s)
- Jocelyn C. Anderson
- College of Nursing, The Pennsylvania State University, University Park, Pennsylvania, USA
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Michelle D.S. Boakye
- College of Nursing, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Zoe Feinstein
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- School of Nursing, Yale University, Orange, Connecticut, USA
| | - Summer Miller-Walfish
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Kelley A. Jones
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Carla D. Chugani
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Alexandra Schmulevich
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Reesha Jackson
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Elizabeth Miller
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Longenecker CT, Jones KA, Hileman CO, Okeke NL, Gripshover BM, Aifah A, Bloomfield GS, Muiruri C, Smith VA, Vedanthan R, Webel AR, Bosworth HB. Nurse-Led Strategy to Improve Blood Pressure and Cholesterol Level Among People With HIV: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2356445. [PMID: 38441897 PMCID: PMC10915684 DOI: 10.1001/jamanetworkopen.2023.56445] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/22/2023] [Indexed: 03/07/2024] Open
Abstract
Importance Despite higher atherosclerotic cardiovascular disease (ASCVD) risk, people with HIV (PWH) experience unique barriers to ASCVD prevention, such as changing models of HIV primary care. Objective To test whether a multicomponent nurse-led strategy would improve systolic blood pressure (SBP) and non-high-density lipoprotein (HDL) cholesterol level in a diverse population of PWH receiving antiretroviral therapy (ART). Design, Setting, and Participants This randomized clinical trial enrolled PWH at 3 academic HIV clinics in the US from September 2019 to January 2022 and conducted follow-up for 12 months until January 2023. Included patients were 18 years or older and had a confirmed HIV diagnosis, an HIV-1 viral load less than 200 copies/mL, and both hypertension and hypercholesterolemia. Participants were stratified by trial site and randomized 1:1 to either the multicomponent EXTRA-CVD (A Nurse-Led Intervention to Extend the HIV Treatment Cascade for Cardiovascular Disease Prevention) intervention group or the control group. Primary analyses were conducted according to the intention-to-treat principle. Intervention The EXTRA-CVD group received home BP monitoring guidance and BP and cholesterol management from a dedicated prevention nurse at 4 in-person visits (baseline and 4, 8, and 12 months) and frequent telephone check-ins up to every 2 weeks as needed. The control group received general prevention education sessions from the prevention nurse at each of the 4 in-person visits. Main Outcomes and Measures Study-measured SBP was the primary outcome, and non-HDL cholesterol level was the secondary outcome. Measurements were taken over 12 months and assessed by linear mixed models. Prespecified moderators tested were sex at birth, baseline ASCVD risk, and trial site. Results A total of 297 PWH were randomized to the EXTRA-CVD arm (n = 149) or control arm (n = 148). Participants had a median (IQR) age of 59.0 (53.0-65.0) years and included 234 males (78.8%). Baseline mean (SD) SBP was 135.0 (18.8) mm Hg and non-HDL cholesterol level was 139.9 (44.6) mg/dL. At 12 months, participants in the EXTRA-CVD arm had a clinically significant 4.2-mm Hg (95% CI, 0.3-8.2 mm Hg; P = .04) lower SBP and 16.9-mg/dL (95% CI, 8.6-25.2 mg/dL; P < .001) lower non-HDL cholesterol level compared with participants in the control arm. There was a clinically meaningful but not statistically significant difference in SBP effect in females compared with males (11.8-mm Hg greater difference at 4 months, 9.6 mm Hg at 8 months, and 5.9 mm Hg at 12 months; overall joint test P = .06). Conclusions and Relevance Results of this trial indicate that the EXTRA-CVD strategy effectively reduced BP and cholesterol level over 12 months and should inform future implementation of multifaceted ASCVD prevention programs for PWH. Trial Registration ClinicalTrials.gov Identifier: NCT03643705.
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Affiliation(s)
| | | | - Corrilynn O. Hileman
- MetroHealth Medical Center, Cleveland, Ohio
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | | | - Barbara M. Gripshover
- Case Western Reserve University School of Medicine, Cleveland, Ohio
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Angela Aifah
- New York University Grossman School of Medicine, New York
| | | | | | - Valerie A. Smith
- Duke University School of Medicine, Durham, North Carolina
- Durham Veterans Affairs Medical Center, Durham, North Carolina
| | | | | | - Hayden B. Bosworth
- Duke University School of Medicine, Durham, North Carolina
- Durham Veterans Affairs Medical Center, Durham, North Carolina
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Petronek MS, Bodeker KL, Lee CY, Teferi N, Eschbacher KL, Jones KA, Loeffler BT, Smith BJ, Buatti JM, Magnotta VA, Allen BG. Iron-based biomarkers for personalizing pharmacological ascorbate therapy in glioblastoma: insights from a phase 2 clinical trial. J Neurooncol 2024; 166:493-501. [PMID: 38285244 DOI: 10.1007/s11060-024-04571-z] [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: 12/08/2023] [Accepted: 01/11/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND Pharmacological ascorbate (intravenous delivery reaching plasma concentrations ≈ 20 mM; P-AscH-) has emerged as a promising therapeutic strategy for glioblastoma. Recently, a single-arm phase 2 clinical trial demonstrated a significant increase in overall survival when P-AscH- was combined with temozolomide and radiotherapy. As P-AscH- relies on iron-dependent mechanisms, this study aimed to assess the predictive potential of both molecular and imaging-based iron-related markers to enhance the personalization of P-AscH- therapy in glioblastoma participants. METHODS Participants (n = 55) with newly diagnosed glioblastoma were enrolled in a phase 2 clinical trial conducted at the University of Iowa (NCT02344355). Tumor samples obtained during surgical resection were processed and stained for transferrin receptor and ferritin heavy chain expression. A blinded pathologist performed pathological assessment. Quantitative susceptibility mapping (QSM) measures were obtained from pre-radiotherapy MRI scans following maximal safe surgical resection. Circulating blood iron panels were evaluated prior to therapy through the University of Iowa Diagnostic Laboratory. RESULTS Through univariate analysis, a significant inverse association was observed between tumor transferrin receptor expression and overall and progression-free survival. QSM measures exhibited a significant, positive association with progression-free survival. Subjects were actively followed until disease progression and then were followed through chart review or clinical visits for overall survival. CONCLUSIONS This study analyzes iron-related biomarkers in the context of P-AscH- therapy for glioblastoma. Integrating molecular, systemic, and imaging-based markers offers a multifaceted approach to tailoring treatment strategies, thereby contributing to improved patient outcomes and advancing the field of glioblastoma therapy.
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Affiliation(s)
- M S Petronek
- Department of Radiation Oncology, Division of Free Radical and Radiation Biology, University of Iowa, Iowa City, IA, USA.
| | - K L Bodeker
- Department of Radiation Oncology, Division of Free Radical and Radiation Biology, University of Iowa, Iowa City, IA, USA
| | - C Y Lee
- Department of Radiology, University of Iowa, Iowa City, IA, USA
| | - N Teferi
- Department of Radiation Oncology, Division of Free Radical and Radiation Biology, University of Iowa, Iowa City, IA, USA
| | - K L Eschbacher
- Department of Pathology, University of Iowa, Iowa City, IA, USA
| | - K A Jones
- Department of Pathology, Division of Neuropathology, Duke University, Durham, NC, USA
| | - B T Loeffler
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
| | - B J Smith
- Department of Biostatistics, University of Iowa, Iowa City, IA, USA
| | - J M Buatti
- Department of Radiation Oncology, Division of Free Radical and Radiation Biology, University of Iowa, Iowa City, IA, USA
| | - V A Magnotta
- Department of Radiology, University of Iowa, Iowa City, IA, USA
| | - B G Allen
- Department of Radiation Oncology, Division of Free Radical and Radiation Biology, University of Iowa, Iowa City, IA, USA
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Coulter RWS, Szoko N, Frankeberger J, Adams B, Jones KA, Chugani CD, Anderson J, Talis J, McCauley HL, Miller E. Gender and Sexual Orientation Differences in Sexual Violence Knowledge, Prevention Behaviors, and Care-Seeking Behaviors. Prev Sci 2024:10.1007/s11121-023-01640-z. [PMID: 38214789 DOI: 10.1007/s11121-023-01640-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2023] [Indexed: 01/13/2024]
Abstract
Sexual violence (SV) on college campuses disproportionately affects cisgender (nontransgender) women, sexual minorities (e.g., gays/lesbians, bisexuals), and gender minority (e.g., transgender/nonbinary) people. This study investigates gender and sexual behavior differences in common SV intervention targets-SV-related knowledge, prevention behaviors, and care-seeking. We analyzed cross-sectional survey data, collected in 9/2015-3/2017, from 2202 students aged 18-24 years attending college health and counseling centers at 28 Pennsylvania and West Virginia campuses. Multivariable multilevel models tested gender and sexual behavior differences in SV history; recognition of SV; prevention behaviors (self-efficacy to obtain sexual consent, intentions to intervene, positive bystander behaviors); and care-seeking behaviors (knowledge of, self-efficacy to use, and actual use of SV services). Adjusting for lifetime exposure to SV, compared with cisgender men, cisgender women had higher recognition of SV and reproductive coercion, prevention behaviors, and care-seeking self-efficacy (beta range 0.19-1.36) and gender minority people had higher recognition of SV and intentions to intervene (beta range 0.33-0.61). Cisgender men with any same-gender sexual partners had higher SV knowledge (beta = 0.23) and self-efficacy to use SV services (beta = 0.52) than cisgender men with only opposite-gender partners. SV history did not explain these differences. Populations most vulnerable to SV generally have higher SV knowledge, prevention behaviors, and care-seeking behaviors than cisgender men with only opposite-gender sexual partners. Innovative SV intervention approaches are necessary to increase SV-related knowledge among heterosexual cisgender men and may need to target alternative mechanisms to effectively reduce inequities for sexual and gender minority people.
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Affiliation(s)
- Robert W S Coulter
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, 120 Lytton Ave, Pittsburgh, PA, 15213, USA.
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA.
| | - Nicholas Szoko
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, 120 Lytton Ave, Pittsburgh, PA, 15213, USA
| | - Jessica Frankeberger
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA
| | - Brian Adams
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA
| | - Kelley A Jones
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, 120 Lytton Ave, Pittsburgh, PA, 15213, USA
| | - Carla D Chugani
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, 120 Lytton Ave, Pittsburgh, PA, 15213, USA
| | - Jocelyn Anderson
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, 120 Lytton Ave, Pittsburgh, PA, 15213, USA
- College of Nursing, Pennsylvania State University, University Park, PA, 16802, USA
| | - Janine Talis
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, 120 Lytton Ave, Pittsburgh, PA, 15213, USA
| | - Heather L McCauley
- School of Social Work, Michigan State University, East Lansing, MI, 48824, USA
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, 120 Lytton Ave, Pittsburgh, PA, 15213, USA
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA
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Jones KA, Clark AG, Greiner MA, Sandoe E, Giri A, Hammill BG, Van Houtven CH, Higgins A, Kaufman B. Linking Medicare-Medicaid Claims for Patient-Centered Outcomes Research Among Dual-Eligible Beneficiaries. Med Care 2023; 61:S131-S138. [PMID: 37963032 PMCID: PMC10635344 DOI: 10.1097/mlr.0000000000001895] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
BACKGROUND Evaluation of Medicare-Medicaid integration models' effects on patient-centered outcomes and costs requires multiple data sources and validated processes for linkage and reconciliation. OBJECTIVE To describe the opportunities and limitations of linking state-specific Medicaid and Centers for Medicare & Medicaid Services administrative claims data to measure patient-centered outcomes for North Carolina dual-eligible beneficiaries. RESEARCH DESIGN We developed systematic processes to (1) validate the beneficiary ID linkage using sex and date of birth in a beneficiary ID crosswalk, (2) verify dates of dual enrollment, and (3) reconcile Medicare-Medicaid claims data to support the development and use of patient-centered outcomes in linked data. PARTICIPANTS North Carolina Medicaid beneficiaries with full Medicaid benefits and concurrent Medicare enrollment (FBDE) between 2014 and 2017. MEASURES We identified need-based subgroups based on service use and eligibility program requirements. We calculated utilization and costs for Medicaid and Medicare, matched Medicaid claims to Medicare service categories where possible, and reported outcomes by the payer. Some services were covered only by Medicaid or Medicare, including Medicaid-only covered home and community-based services (HCBS). RESULTS Of 498,030 potential dual enrollees, we verified the linkage and FBDE eligibility of 425,664 (85.5%) beneficiaries, including 281,174 adults enrolled in Medicaid and Medicare fee-for-service. The most common need-based subgroups were intensive behavioral health service users (26.2%) and HCBS users (10.8%) for adults under age 65, and HCBS users (20.6%) and nursing home residents (12.4%) for adults age 65 and over. Medicaid funded 42% and 49% of spending for adults under 65 and adults 65 and older, respectively. Adults under 65 had greater behavioral health service utilization but less skilled nursing facility, HCBS, and home health utilization compared with adults 65 and older. CONCLUSIONS Linkage of Medicare-Medicaid data improves understanding of patient-centered outcomes among FBDE by combining Medicare-funded acute and ambulatory services with Medicaid-funded HCBS. Using linked Medicare-Medicaid data illustrates the diverse patient experience within FBDE beneficiaries, which is key to informing patient-centered outcomes, developing and evaluating integrated Medicare and Medicaid programs, and promoting health equity.
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Affiliation(s)
- Kelley A. Jones
- Department of Population Health Sciences, Duke University School of Medicine, Durham
| | - Amy G. Clark
- Department of Population Health Sciences, Duke University School of Medicine, Durham
| | - Melissa A. Greiner
- Department of Population Health Sciences, Duke University School of Medicine, Durham
| | - Emma Sandoe
- Department of Population Health Sciences, Duke University School of Medicine, Durham
- North Carolina Department of Health and Human Services, Raleigh
| | - Abhigya Giri
- Duke Margolis Center for Health Policy, Duke University, Durham, NC
| | - Bradley G. Hammill
- Department of Population Health Sciences, Duke University School of Medicine, Durham
| | - Courtney H. Van Houtven
- Department of Population Health Sciences, Duke University School of Medicine, Durham
- Duke Margolis Center for Health Policy, Duke University, Durham, NC
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA
| | - Aparna Higgins
- Duke Margolis Center for Health Policy, Duke University, Durham, NC
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA
- Ananya Health Solutions LLC, Dunn Loring, VA Medical Center, Durham, NC
| | - Brystana Kaufman
- Department of Population Health Sciences, Duke University School of Medicine, Durham
- Duke Margolis Center for Health Policy, Duke University, Durham, NC
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA
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7
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Freed SS, Jones KA, Whitaker RG, Norman K, Carvalho M, Giri A, Lake A, Tchuisseu YP, Repka S, Vasudeva K, Bey N, Bettger JP. Evaluating Telehealth Uptake Among North Carolina Medicaid Beneficiaries With Musculoskeletal Conditions: Insights From the COVID-19 Pandemic. Med Care 2023; 61:750-759. [PMID: 37733405 DOI: 10.1097/mlr.0000000000001915] [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: 09/22/2023]
Abstract
BACKGROUND The shift from in-person to virtual visits, known as telehealth (TH), during the COVID-19 pandemic was a significant change for North Carolina (NC) Medicaid beneficiaries seeking treatment for musculoskeletal (MSK) conditions, as remote care for these conditions was previously unavailable. We used this policy change to investigate factors associated with TH uptake and whether TH availability mitigated disparities in access to care or affected emergency department (ED) visits among these beneficiaries. RESEARCH DESIGN Using 2019-2021 NC Medicaid claims, we identified beneficiaries receiving treatment for MSK conditions before COVID-19 (March 2019-February 2020) and analyzed uptake of newly available TH during COVID-19 (April 2020-March 2021). We used descriptive analysis and Poisson generalized estimating equations to quantify TH uptake, factors associated with TH uptake, and the association with ED visits during COVID-19. RESULTS Black and Hispanic beneficiaries were less likely to use TH compared with White and non-Hispanic counterparts (10%, P <0.001 and 20%, P =0.03, respectively). Adults eligible for Tailored Plans, specialized NC Medicaid plans for those with significant behavioral health needs or intellectual/developmental disabilities, were less likely to use TH [adjusted risk ratio (ARR):0.83, 95% CI (0.78, 0.87)]; youth eligible for Tailored Plans were more likely to use TH [ARR:1.28, 95% CI (1.16, 1.42)]. Lower county-level internet access was associated with lower TH use [ARR: 0.85, 95% CI (0.82, 0.99)]. No statistical difference in ED utilization was observed between TH users and non-users. CONCLUSIONS TH has the potential to deliver convenient care to beneficiaries with MSK conditions who can access it. Further research and policy changes should explore and address underlying factors driving disparities and improve equitable access to care for this population.
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Affiliation(s)
- Salama S Freed
- Department of Health Policy and Management, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Kelley A Jones
- Department of Population Health Sciences, Duke University School of Medicine
| | | | - Katherine Norman
- Department of Population Health Sciences, Duke University School of Medicine
| | - Marissa Carvalho
- Department of Physical Therapy and Occupational Therapy, Duke Health, Durham NC
| | - Abhigya Giri
- Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Ashley Lake
- Duke Physical Therapy Sports Medicine at Center for Living, Duke University, Durham
| | | | | | - Karina Vasudeva
- Department of Health Policy and Management, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Nadia Bey
- Duke Margolis Center for Health Policy, Duke University
| | - Janet Prvu Bettger
- Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, PA
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8
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Jones KA, Goodfield NER. Early prediction of chemotherapy-induced cardiotoxicity. J Nucl Cardiol 2023; 30:2112-2113. [PMID: 36977898 DOI: 10.1007/s12350-023-03251-1] [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] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 03/03/2023] [Indexed: 03/30/2023]
Affiliation(s)
- K A Jones
- Department of Nuclear Cardiology, Glasgow Royal Infirmary, Glasgow, UK.
- School of Physics and Astronomy, University of Glasgow, Glasgow, UK.
| | - N E R Goodfield
- Department of Nuclear Cardiology, Glasgow Royal Infirmary, Glasgow, UK
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Ming DY, Wong W, Jones KA, Antonelli RC, Gujral N, Gonzales S, Rogers U, Ratliff W, Shah N, King HA. Feasibility of Implementation of a Mobile Digital Personal Health Record to Coordinate Care for Children and Youth With Special Health Care Needs in Primary Care: Protocol for a Mixed Methods Study. JMIR Res Protoc 2023; 12:e46847. [PMID: 37728977 PMCID: PMC10551780 DOI: 10.2196/46847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Electronic health record (EHR)-integrated digital personal health records (PHRs) via Fast Healthcare Interoperability Resources (FHIR) are promising digital health tools to support care coordination (CC) for children and youth with special health care needs but remain widely unadopted; as their adoption grows, mixed methods and implementation research could guide real-world implementation and evaluation. OBJECTIVE This study (1) evaluates the feasibility of an FHIR-enabled digital PHR app for CC for children and youth with special health care needs, (2) characterizes determinants of implementation, and (3) explores associations between adoption and patient- or family-reported outcomes. METHODS This nonrandomized, single-arm, prospective feasibility trial will test an FHIR-enabled digital PHR app's use among families of children and youth with special health care needs in primary care settings. Key app features are FHIR-enabled access to structured data from the child's medical record, families' abilities to longitudinally track patient- or family-centered care goals, and sharing progress toward care goals with the child's primary care provider via a clinician dashboard. We shall enroll 40 parents or caregivers of children and youth with special health care needs to use the app for 6 months. Inclusion criteria for children and youth with special health care needs are age 0-16 years; primary care at a participating site; complex needs benefiting from CC; high hospitalization risk in the next 6 months; English speaking; having requisite technology at home (internet access, Apple iOS mobile device); and an active web-based EHR patient portal account to which a parent or caregiver has full proxy access. Digital prescriptions will be used to disseminate study recruitment materials directly to eligible participants via their existing EHR patient portal accounts. We will apply an intervention mixed methods design to link quantitative and qualitative (semistructured interviews and family engagement panels with parents of children and youth with special health care needs) data and characterize implementation determinants. Two CC frameworks (Pediatric Care Coordination Framework; Patient-Centered Medical Home) and 2 evaluation frameworks (Consolidated Framework for Implementation Research; Technology Acceptance Model) provide theoretical foundations for this study. RESULTS Participant recruitment began in fall 2022, before which we identified >300 potentially eligible patients in EHR data. A family engagement panel in fall 2021 generated formative feedback from family partners. Integrated analysis of pretrial quantitative and qualitative data informed family-centered enhancements to study procedures. CONCLUSIONS Our findings will inform how to integrate an FHIR-enabled digital PHR app for children and youth with special health care needs into clinical care. Mixed methods and implementation research will help strengthen implementation in diverse clinical settings. The study is positioned to advance knowledge of how to use digital health innovations for improving care and outcomes for children and youth with special health care needs and their families. TRIAL REGISTRATION ClinicalTrials.gov NCT05513235; https://clinicaltrials.gov/study/NCT05513235. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/46847.
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Affiliation(s)
- David Y Ming
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Willis Wong
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States
| | - Kelley A Jones
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Richard C Antonelli
- Department of Pediatrics, Boston Children's Hospital, Harvard School of Medicine, Boston, MA, United States
| | - Nitin Gujral
- Innovation and Digital Health Accelerator, Boston Children's Hospital, Boston, MA, United States
| | - Sarah Gonzales
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Ursula Rogers
- AI Health, Duke University School of Medicine, Durham, NC, United States
| | - William Ratliff
- Duke Institute for Health Innovation, Duke University School of Medicine, Durham, NC, United States
| | - Nirmish Shah
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Heather A King
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veteran Affairs Health Care System, Durham, NC, United States
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French A, Jones KA, Bettger JP, Maslow GR, Cholera R, Giri A, Swietek K, Tchuisseu YP, Repka S, Freed S, Whitaker R. Telehealth Utilization Among Adult Medicaid Beneficiaries in North Carolina with Behavioral Health Conditions During the COVID-19 Pandemic. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01730-2. [PMID: 37584807 PMCID: PMC11006092 DOI: 10.1007/s40615-023-01730-2] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/19/2023] [Accepted: 07/21/2023] [Indexed: 08/17/2023]
Abstract
OBJECTIVE We examined factors associated with telehealth utilization during COVID-19 among adult Medicaid beneficiaries with behavioral health conditions. DATA SOURCES AND STUDY SETTING NC Medicaid 2019-2021 beneficiary and claims data. STUDY DESIGN This retrospective cohort study examined and compared behavioral health service use pre-COVID-19 (03/01/2019 to 02/28/2020) and during COVID-19 (04/01/2020 to 03/31/2021). Telehealth users included those with at least one behavioral health visit via telehealth during COVID-19. Descriptive statistics were calculated for overall sample and by telehealth status. Multilevel modified Poisson generalized estimating equation examined associations between telehealth use and patient- and area-level characteristics. DATA COLLECTION/EXTRACTION METHODS We identified individuals ages ≥ 21-64, diagnosed with a behavioral health condition, and had at least one behavioral-health specific visit before COVID-19. PRINCIPAL FINDINGS Almost two-thirds of the cohort received behavioral health services during COVID-19, with half of these beneficiaries using telehealth. Non-telehealth users had steeper declines in service use from pre- to during COVID-19 compared to telehealth users. Beneficiaries identifying as Black, multiracial or other were significantly less likely to use telehealth (ARR = 0.86; 95% CI: (0.83, 0.89)); (ARR = 0.92; 95% CI: (0.87, 0.96)) compared to White beneficiaries. Those eligible for Medicaid through the blind/disabled programs and who qualified for a state-specific specialized behavioral health plan were more likely to use telehealth (17% and 20%, respectively). CONCLUSIONS During the pandemic, telehealth facilitated continuity of care for beneficiaries with behavioral health conditions. Future research should aim to investigate how to reduce the digital divide and ensure equitable access to telehealth.
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Affiliation(s)
- Alexis French
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2608 Erwin Dr., Suite 300, Durham, NC, 27705, USA.
| | - Kelley A Jones
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St, Durham, NC, 27701, USA
| | - Janet Prvu Bettger
- Department of Health and Rehabilitation Sciences, Temple University, 1700 N. Broad Street, Suite 300, Philadelphia, PA, 19121, USA
| | - Gary R Maslow
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2608 Erwin Dr., Suite 300, Durham, NC, 27705, USA
- Department of Pediatrics, Duke University School of Medicine, 4020 N Roxboro St, Box 3675, Durham, NC, 27710, USA
| | - Rushina Cholera
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St, Durham, NC, 27701, USA
- Department of Pediatrics, Duke University School of Medicine, 4020 N Roxboro St, Box 3675, Durham, NC, 27710, USA
- Duke Margolis Center for Health Policy, Duke University, 100 Fuqua Drive, Box 90120, Durham, NC, 27708, USA
| | - Abhigya Giri
- The George Washington University Biostatistics Center, 6110 Executive Blvd, Rockville, MD, 20852, USA
| | - Karen Swietek
- NORC at the University of Chicago, 1 Broadway, 14Th Floor, Cambridge, MA, 02142, USA
| | - Yolande Pokam Tchuisseu
- Duke Margolis Center for Health Policy, Duke University, 100 Fuqua Drive, Box 90120, Durham, NC, 27708, USA
| | - Samantha Repka
- Duke Margolis Center for Health Policy, Duke University, 100 Fuqua Drive, Box 90120, Durham, NC, 27708, USA
| | - Salama Freed
- Health Policy and Management, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue, 6th Floor, Washington, DC, 20052, USA
| | - Rebecca Whitaker
- Duke Margolis Center for Health Policy, Duke University, 100 Fuqua Drive, Box 90120, Durham, NC, 27708, USA
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Kaufman BG, Jones KA, Greiner MA, Giri A, Stewart L, He A, Clark AG, Taylor DH, Bundorf MK, Whitaker RG, Van Houtven CH, Higgins A. Health Care Use and Spending Among Need-Based Subgroups of Medicare Beneficiaries With Full Medicaid Benefits. JAMA Health Forum 2023; 4:e230973. [PMID: 37171797 PMCID: PMC10182424 DOI: 10.1001/jamahealthforum.2023.0973] [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: 05/13/2023] Open
Abstract
Importance Beneficiaries dual eligible for Medicare and Medicaid account for a disproportionate share of expenditures due to their complex care needs. Lack of coordination between payment programs creates misaligned incentives, resulting in higher costs, fragmented care, and poor health outcomes. Objective To inform the design of integrated programs by describing the health care use and spending for need-based subgroups in North Carolina's full benefit, dual-eligible population. Design, Setting, and Participants This cross-sectional study using Medicare and North Carolina Medicaid 100% claims data (2014-2017) linked at the individual level included Medicare beneficiaries with full North Carolina Medicaid benefits. Data were analyzed between 2021 and 2022. Exposure Need-based subgroups: community well, home- and community-based services (HCBS) users, nursing home (NH) residents, and intensive behavioral health (BH) users. Measures Medicare and Medicaid utilization and spending per person-year (PPY). Results The cohort (n = 333 240) comprised subgroups of community well (64.1%, n = 213 667), HCBS users (15.0%, n = 50 095), BH users (15.2%, n = 50 509), and NH residents (7.5%, n = 24 927). Overall, 61.1% reported female sex. The most common racial identities included Asian (1.8%), Black (36.1%), and White (58.7%). Combined spending for Medicare and Medicaid was $26 874 PPY, and the funding of care was split evenly between Medicare and Medicaid. Among need-based subgroups, combined spending was lowest among community well at $19 734 PPY with the lowest portion (38.5%) of spending contributed by Medicaid ($7605). Among NH residents, overall spending ($68 359) was highest, and the highest portion of spending contributed by Medicaid (70.1%). Key components of spending among HCBS users' combined total of $40 069 PPY were clinician services on carrier claims ($14 523) and outpatient facility services ($9012). Conclusions and relevance Federal and state policy makers and administrators are developing strategies to integrate Medicare- and Medicaid-funded health care services to provide better care to the people enrolled in both programs. Substantial use of both Medicare- and Medicaid-funded services was found across all need-based subgroups, and the services contributing a high proportion of the total spending differed across subgroups. The diversity of health care use suggests a tailored approach to integration strategies with comprehensive set benefits that comprises Medicare and Medicaid services, including long-term services and supports, BH, palliative care, and social services.
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Affiliation(s)
- Brystana G Kaufman
- Duke Margolis Center for Health Policy, Duke University, Durham, North Carolina
- Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, North Carolina
| | - Kelley A Jones
- Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Melissa A Greiner
- Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Abhigya Giri
- Duke Margolis Center for Health Policy, Duke University, Durham, North Carolina
| | - Lucas Stewart
- Duke Margolis Center for Health Policy, Duke University, Durham, North Carolina
| | - Amanda He
- Duke Margolis Center for Health Policy, Duke University, Durham, North Carolina
| | - Amy G Clark
- Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Donald H Taylor
- Duke Margolis Center for Health Policy, Duke University, Durham, North Carolina
- Sanford School of Public Health Policy, Duke University, Durham, North Carolina
| | - M Kate Bundorf
- Duke Margolis Center for Health Policy, Duke University, Durham, North Carolina
- Sanford School of Public Health Policy, Duke University, Durham, North Carolina
| | - Rebecca G Whitaker
- Duke Margolis Center for Health Policy, Duke University, Durham, North Carolina
| | - Courtney H Van Houtven
- Duke Margolis Center for Health Policy, Duke University, Durham, North Carolina
- Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, North Carolina
| | - Aparna Higgins
- Duke Margolis Center for Health Policy, Duke University, Durham, North Carolina
- Founder, Ananya Health Solutions LLC, Dunn Loring, Virginia
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Jones KA, Paterson CA, Ray S, Motherwell DW, Hamilton DJ, Small AD, Martin W, Goodfield NER. Beta-blockers and mechanical dyssynchrony in heart failure assessed by radionuclide ventriculography. J Nucl Cardiol 2023; 30:193-200. [PMID: 36417121 PMCID: PMC9984517 DOI: 10.1007/s12350-022-03142-x] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/08/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Radionuclide ventriculography (RNVG) can be used to quantify mechanical dyssynchrony and may be a valuable adjunct in the assessment of heart failure with reduced ejection fraction (HFrEF). The study aims to investigate the effect of beta-blockers on mechanical dyssynchrony using novel RNVG phase parameters. METHODS A retrospective study was carried out in a group of 98 patients with HFrEF. LVEF and dyssynchrony were assessed pre and post beta-blockade. Dyssynchrony was assessed using synchrony, entropy, phase standard deviation, approximate entropy, and sample entropy from planar RNVG phase images. Subgroups split by ischemic etiology were also investigated. RESULTS An improvement in dyssynchrony and LVEF was measured six months post beta-blockade for both ischemic and non-ischemic groups. CONCLUSIONS A significant improvement in dyssynchrony and LVEF was measured post beta-blockade using novel measures of dyssynchrony.
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Affiliation(s)
- K A Jones
- Department of Nuclear Cardiology, Glasgow Royal Infirmary, Glasgow, UK.
- School of Physics and Astronomy, University of Glasgow, Glasgow, UK.
| | - C A Paterson
- Department of Nuclear Cardiology, Glasgow Royal Infirmary, Glasgow, UK
- School of Physics and Astronomy, University of Glasgow, Glasgow, UK
| | - S Ray
- School of Mathematics and Statistics, University of Glasgow, Glasgow , UK
| | - D W Motherwell
- Department of Nuclear Cardiology, Glasgow Royal Infirmary, Glasgow, UK
| | - D J Hamilton
- School of Physics and Astronomy, University of Glasgow, Glasgow, UK
| | - A D Small
- Department of Nuclear Cardiology, Glasgow Royal Infirmary, Glasgow, UK
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - W Martin
- Department of Nuclear Cardiology, Glasgow Royal Infirmary, Glasgow, UK
- School of Physics and Astronomy, University of Glasgow, Glasgow, UK
| | - N E R Goodfield
- Department of Nuclear Cardiology, Glasgow Royal Infirmary, Glasgow, UK
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Tang S, Paglisotti TE, Ports KA, Abebe KZ, Jones KA, Levtov R, Kato-Wallace J, Miller E. Cost Analysis of Community-Based Violence Prevention Programs: Manhood 2.0 and Job Skills Programs. J Fam Violence 2022; 39:449-456. [PMID: 38617027 PMCID: PMC11010587 DOI: 10.1007/s10896-022-00481-8] [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] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 11/27/2022] [Accepted: 11/30/2022] [Indexed: 04/16/2024]
Abstract
Purpose Sexual violence (SV) and adolescent relationship abuse (ARA) are common in the U. S. and have strong associations with negative health and wellbeing outcomes. Manhood 2.0 is the first U.S. program designed for community settings to build bystander skills while also challenging harmful gender norms. A cluster-randomized trial comparing Manhood 2.0 to Job Skills, a job readiness training control condition, demonstrated that it is a promising strategy to prevent sexual violence and adolescent relationship abuse. Such community-based interventions may be particularly relevant in lower resource urban settings, and the costs of such prevention programs have not been considered previously. Methods The aim of the present study is to perform systematic and standardized cost calculations associated with implementing Manhood 2.0 among adolescent males. In addition, this study provides detailed cost information of the community-based intervention program, as well as costs associated with implementing the Job Skills control program. Program implementation data were recorded throughout the study period (2015-2019) by the Manhood 2.0 study team. Results The cost of implementing Manhood 2.0 is $4,771 per complete round of program delivery and $451 per participant, which is approximately the same cost as the control Job Skills program ($4,432 and $453 per participant). The marginal cost per additional round of Manhood 2.0 program is $3,682. Conclusion Implementation of a community-based program requires substantial resources and collaborations with community partners especially in economically disadvantaged neighborhoods. This study provides a snapshot of the cost information of a community-based intervention program from the implementing agency's perspective, which is essential in helping decision-makers understand the costs they will incur by implementing prevention programs and ensuring program feasibility and sustainability.
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Affiliation(s)
- Shichao Tang
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, US
- Present address: Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Mailstop S107-3, 4770 Buford Highway NE, GA - Georgia 30341 Atlanta, United States
| | - T. Even Paglisotti
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, US
| | - Katie A. Ports
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, US
| | - Kaleab Z. Abebe
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, US
| | - Kelley A. Jones
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, US
| | | | | | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, US
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Ming DY, Jones KA, White MJ, Pritchard JE, Hammill BG, Bush C, Jackson GL, Raman SR. Healthcare Utilization for Medicaid-Insured Children with Medical Complexity: Differences by Sociodemographic Characteristics. Matern Child Health J 2022; 26:2407-2418. [PMID: 36198851 PMCID: PMC10026355 DOI: 10.1007/s10995-022-03543-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To compare differences in healthcare utilization and costs for Medicaid-insured children with medical complexity (CMC) by race/ethnicity and rurality. METHODS Retrospective cohort of North Carolina (NC) Medicaid claims for children 3-20 years old with 3 years continuous Medicaid coverage (10/1/2015-9/30/2018). Exposures were medical complexity, race/ethnicity, and rurality. Three medical complexity levels were: without chronic disease, non-complex chronic disease, and complex chronic disease; the latter were defined as CMC. Race/ethnicity was self-reported in claims; we defined rurality by home residence ZIP codes. Utilization and costs were summarized for 1 year (10/1/2018-9/30/2019) by complexity level classification and categorized as acute care (hospitalization, emergency [ED]), outpatient care (primary, specialty, allied health), and pharmacy. Per-complexity group utilization rates (per 1000 person-years) by race/ethnicity and rurality were compared using adjusted rate ratios (ARR). RESULTS Among 859,166 Medicaid-insured children, 118,210 (13.8%) were CMC. Among CMC, 36% were categorized as Black non-Hispanic, 42.7% White non-Hispanic, 14.3% Hispanic, and 35% rural. Compared to White non-Hispanic CMC, Black non-Hispanic CMC had higher hospitalization (ARR = 1.12; confidence interval, CI 1.08-1.17) and ED visit (ARR = 1.17; CI 1.16-1.19) rates; Hispanic CMC had lower ED visit (ARR = 0.77; CI 0.75-0.78) and hospitalization rates (ARR = 0.79; CI 0.73-0.84). Black non-Hispanic and Hispanic CMC had lower outpatient visit rates than White non-Hispanic CMC. Rural CMC had higher ED (ARR = 1.13; CI 1.11-1.15) and lower primary care utilization rates (ARR = 0.87; CI 0.86-0.88) than urban CMC. DISCUSSION Healthcare utilization varied by race/ethnicity and rurality for Medicaid-insured CMC. Further studies should investigate mechanisms for these variations and expand higher value, equitable care delivery for CMC.
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Affiliation(s)
- David Y Ming
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
- Department of Pediatrics, Duke University School of Medicine, Box 102376, Durham, NC, 27710, USA.
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
| | - Kelley A Jones
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Michelle J White
- Department of Pediatrics, Duke University School of Medicine, Box 102376, Durham, NC, 27710, USA
| | - Jessica E Pritchard
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Bradley G Hammill
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | | | - George L Jackson
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Sudha R Raman
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
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French A, Jones KA, Bush C, Greiner MA, Copeland JN, Davis NO, Franklin MS, Heilbron N, Maslow GR. Racial and Ethnic Differences in Psychotropic Prescription Receipt Among Pediatric Patients Enrolled in North Carolina Medicaid. Psychiatr Serv 2022; 73:1401-1404. [PMID: 36039550 DOI: 10.1176/appi.ps.202100473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors aimed to examine racial-ethnic differences in filled psychotropic prescriptions among a pediatric Medicaid population. METHODS This retrospective cohort study included patients ages 0-21 with at least one North Carolina Medicaid claim from October 1, 2017, through September 30, 2018 (N=983,886). The primary outcome was a filled psychotropic prescription. Separate multivariable modified Poisson regression models generated adjusted risk ratios (ARRs) and 95% confidence intervals (CIs), adjusted for patient demographic characteristics. RESULTS Black and Hispanic patients were significantly less likely to receive any filled psychotropic prescription (ARR=0.61, 95% CI=0.60-0.62; ARR=0.29, 95% CI=0.28-0.29, respectively) compared with White and non-Hispanic patients. Furthermore, Black and Hispanic patients were less likely to receive filled prescriptions in the four included drug classes compared with White and non-Hispanic patients. CONCLUSIONS Future studies should focus on understanding the factors contributing to racial and ethnic differences among pediatric patients receiving filled psychotropic prescriptions.
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Affiliation(s)
- Alexis French
- Department of Psychiatry and Behavioral Sciences (French, Copeland, Davis, Heilbron, Maslow), Department of Population Health Sciences (Jones, Greiner), and Department of Pediatrics (Maslow), Duke University School of Medicine, Durham, North Carolina; Aetion, New York City (Bush); Duke-Margolis Center for Health Policy, Durham, North Carolina (Franklin); Carolina Institute for Developmental Disabilities, University of North Carolina School of Medicine, Chapel Hill (Franklin)
| | - Kelley A Jones
- Department of Psychiatry and Behavioral Sciences (French, Copeland, Davis, Heilbron, Maslow), Department of Population Health Sciences (Jones, Greiner), and Department of Pediatrics (Maslow), Duke University School of Medicine, Durham, North Carolina; Aetion, New York City (Bush); Duke-Margolis Center for Health Policy, Durham, North Carolina (Franklin); Carolina Institute for Developmental Disabilities, University of North Carolina School of Medicine, Chapel Hill (Franklin)
| | - Christopher Bush
- Department of Psychiatry and Behavioral Sciences (French, Copeland, Davis, Heilbron, Maslow), Department of Population Health Sciences (Jones, Greiner), and Department of Pediatrics (Maslow), Duke University School of Medicine, Durham, North Carolina; Aetion, New York City (Bush); Duke-Margolis Center for Health Policy, Durham, North Carolina (Franklin); Carolina Institute for Developmental Disabilities, University of North Carolina School of Medicine, Chapel Hill (Franklin)
| | - Melissa A Greiner
- Department of Psychiatry and Behavioral Sciences (French, Copeland, Davis, Heilbron, Maslow), Department of Population Health Sciences (Jones, Greiner), and Department of Pediatrics (Maslow), Duke University School of Medicine, Durham, North Carolina; Aetion, New York City (Bush); Duke-Margolis Center for Health Policy, Durham, North Carolina (Franklin); Carolina Institute for Developmental Disabilities, University of North Carolina School of Medicine, Chapel Hill (Franklin)
| | - J Nathan Copeland
- Department of Psychiatry and Behavioral Sciences (French, Copeland, Davis, Heilbron, Maslow), Department of Population Health Sciences (Jones, Greiner), and Department of Pediatrics (Maslow), Duke University School of Medicine, Durham, North Carolina; Aetion, New York City (Bush); Duke-Margolis Center for Health Policy, Durham, North Carolina (Franklin); Carolina Institute for Developmental Disabilities, University of North Carolina School of Medicine, Chapel Hill (Franklin)
| | - Naomi O Davis
- Department of Psychiatry and Behavioral Sciences (French, Copeland, Davis, Heilbron, Maslow), Department of Population Health Sciences (Jones, Greiner), and Department of Pediatrics (Maslow), Duke University School of Medicine, Durham, North Carolina; Aetion, New York City (Bush); Duke-Margolis Center for Health Policy, Durham, North Carolina (Franklin); Carolina Institute for Developmental Disabilities, University of North Carolina School of Medicine, Chapel Hill (Franklin)
| | - Michelle S Franklin
- Department of Psychiatry and Behavioral Sciences (French, Copeland, Davis, Heilbron, Maslow), Department of Population Health Sciences (Jones, Greiner), and Department of Pediatrics (Maslow), Duke University School of Medicine, Durham, North Carolina; Aetion, New York City (Bush); Duke-Margolis Center for Health Policy, Durham, North Carolina (Franklin); Carolina Institute for Developmental Disabilities, University of North Carolina School of Medicine, Chapel Hill (Franklin)
| | - Nicole Heilbron
- Department of Psychiatry and Behavioral Sciences (French, Copeland, Davis, Heilbron, Maslow), Department of Population Health Sciences (Jones, Greiner), and Department of Pediatrics (Maslow), Duke University School of Medicine, Durham, North Carolina; Aetion, New York City (Bush); Duke-Margolis Center for Health Policy, Durham, North Carolina (Franklin); Carolina Institute for Developmental Disabilities, University of North Carolina School of Medicine, Chapel Hill (Franklin)
| | - Gary R Maslow
- Department of Psychiatry and Behavioral Sciences (French, Copeland, Davis, Heilbron, Maslow), Department of Population Health Sciences (Jones, Greiner), and Department of Pediatrics (Maslow), Duke University School of Medicine, Durham, North Carolina; Aetion, New York City (Bush); Duke-Margolis Center for Health Policy, Durham, North Carolina (Franklin); Carolina Institute for Developmental Disabilities, University of North Carolina School of Medicine, Chapel Hill (Franklin)
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Franklin MS, Bush C, Jones KA, Davis NO, French A, Howard J, Greiner MA, Maslow GR. Inequities in Receipt of the North Carolina Medicaid Waiver Among Individuals with Intellectual Disability or Autism Spectrum Disorder. J Dev Behav Pediatr 2022; 43:393-401. [PMID: 35353786 PMCID: PMC9462136 DOI: 10.1097/dbp.0000000000001075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 01/07/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We examined characteristics associated with receiving the North Carolina Home and Community-Based Services Waiver for intellectual and developmental disabilities (I/DDs) and its association with emergency department (ED) utilization. METHOD Through analysis of the North Carolina 2017 to 2018 Medicaid claims and enrollment data, we examined characteristics (age, sex, race and ethnicity, geography, diagnosis (intellectual disability [ID] with or without autism spectrum disorders or autism spectrum disorder without ID) associated with receiving the NC I/DD Waiver and the association of this Wavier with ED utilization. We identified patients with at least 1 International Classification of Diseases-10-CM diagnosis code for an ID or autism spectrum disorder. We excluded patients with missing county information and whose enrollment in the NC I/DD Waiver program began after October 1, 2017. RESULTS Only 22% of 53,531 individuals with I/DD in North Carolina received the Waiver. Non-Hispanic Blacks and Hispanic individuals were less likely to receive the Waiver than non-Hispanic White individuals. Adults (>21 years old), men, and urban residents were more likely to receive the Waiver. Individuals who received the Waiver were 31% less likely to use the ED. CONCLUSION Innovative strategies are needed to provide equitable access to the NC I/DD Waiver and provide services to the 14,000 people with I/DD currently waiting to receive the Waiver. Through the Waiver, those with I/DD can access preventative and therapeutic outpatient services and decrease their need for ED care. These findings highlight the need for policy reform to address inequities in access to the Waiver for individuals with I/DD.
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Affiliation(s)
| | - Christopher Bush
- Department of Population Health Sciences, Duke University, Durham, NC
| | - Kelley A. Jones
- Department of Population Health Sciences, Duke University, Durham, NC
| | - Naomi Ornstein Davis
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Alexis French
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Jill Howard
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | | | - Gary R. Maslow
- Department of Pediatrics, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
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17
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Anderson JC, Feinstein Z, Edwards C, Jones KA, Van Dusen C, Kehr V, Burrell C, Coulter RW, Miller E, Chugani CD. Provider perspectives on implementing a student health and counseling center intervention for sexual violence. J Am Coll Health 2022; 70:1363-1371. [PMID: 32721195 PMCID: PMC7855319 DOI: 10.1080/07448481.2020.1797752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/20/2019] [Accepted: 02/29/2020] [Indexed: 06/11/2023]
Abstract
Objective: To describe provider experiences with implementation of the GIFTSS (Giving Information for Trauma Support and Safety) intervention. Participants: Health and counseling center staff from participating campuses attended trainings between August 2015 and August 2016. Interviews were conducted between May and August 2017. Methods: Providers (n = 230) completed surveys prior to and six months following a 3-hour training on the intervention. Structured phone interviews were conducted with a purposively selected subset of 14 providers. Results: Overall, staff found the intervention acceptable. Implementation barriers noted were time and competing patient priorities. Providers noted variation based on patient and visit characteristics. Clinic commitment, particularly in adopting strategies for universal dissemination of the GIFTSS card, was seen as helpful. Conclusion: Implementation of a brief trauma-informed intervention in campus health and counseling centers was feasible and acceptable to most providers. Opportunities to change organizational culture regarding ensuring adequate time and safety for patients are discussed.
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Affiliation(s)
- Jocelyn C. Anderson
- University of Pittsburgh School of Medicine, Department of Pediatrics and UPMC Children’s Hospital of Pittsburgh, Division of Adolescent and Young Adult Medicine, Pittsburgh, PA
- Pennsylvania State University, College of Nursing, State College, PA
| | - Zoe Feinstein
- University of Pittsburgh School of Medicine, Department of Pediatrics and UPMC Children’s Hospital of Pittsburgh, Division of Adolescent and Young Adult Medicine, Pittsburgh, PA
| | | | - Kelley A. Jones
- University of Pittsburgh School of Medicine, Department of Pediatrics and UPMC Children’s Hospital of Pittsburgh, Division of Adolescent and Young Adult Medicine, Pittsburgh, PA
| | - Courtney Van Dusen
- University of Pittsburgh School of Medicine, Department of Pediatrics and UPMC Children’s Hospital of Pittsburgh, Division of Adolescent and Young Adult Medicine, Pittsburgh, PA
| | - Vanessa Kehr
- University of Pittsburgh School of Medicine, Department of Pediatrics and UPMC Children’s Hospital of Pittsburgh, Division of Adolescent and Young Adult Medicine, Pittsburgh, PA
| | | | - Robert W.S. Coulter
- University of Pittsburgh School of Medicine, Department of Pediatrics and UPMC Children’s Hospital of Pittsburgh, Division of Adolescent and Young Adult Medicine, Pittsburgh, PA
- University of Pittsburgh Graduate School of Public Health, Department of Behavioral and Community Health Sciences, Pittsburgh, PA
| | - Elizabeth Miller
- University of Pittsburgh School of Medicine, Department of Pediatrics and UPMC Children’s Hospital of Pittsburgh, Division of Adolescent and Young Adult Medicine, Pittsburgh, PA
| | - Carla D. Chugani
- University of Pittsburgh School of Medicine, Department of Pediatrics and UPMC Children’s Hospital of Pittsburgh, Division of Adolescent and Young Adult Medicine, Pittsburgh, PA
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18
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Jones KA, Goodfield NER. Mechanical dyssynchrony and super-response to CRT. J Nucl Cardiol 2022; 29:1175-1177. [PMID: 33403513 DOI: 10.1007/s12350-020-02453-1] [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] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 11/16/2020] [Indexed: 10/22/2022]
Affiliation(s)
- K A Jones
- Department of Nuclear Cardiology, Glasgow Royal Infirmary, Glasgow, UK.
- School of Physics and Astronomy, University of Glasgow, Glasgow, UK.
| | - N E R Goodfield
- Department of Nuclear Cardiology, Glasgow Royal Infirmary, Glasgow, UK
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19
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Shepherd-Banigan M, Jones KA, Sullivan C, Wang K, Clark AG, Van Houtven C, Olsen JM. Individual and program Characteristics May Drive Variability in Outcomes After Caregivers Participate in a Tailored Support Intervention. J Appl Gerontol 2022; 41:1960-1970. [PMID: 35575158 PMCID: PMC9364230 DOI: 10.1177/07334648221091564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Critically needed programs designed to support family caregivers have shown
inconsistent reductions in stress and burden. To explore drivers of improvement
in caregiver outcomes after participation in a support intervention we analyzed
data from a one-on-one, tailored problem-solving intervention targeting
caregiver wellbeing (2015–2019, n = 503). We explored data
patterns across 21 individual, household, and program-level variables using
elastic net regression to identify drivers of improvements, and their relative
importance. Baseline subjective burden, baseline depressive symptom scores,
baseline caregiver problem solving, African American race, and site and coach
fixed effects were the most consistent drivers of changes across the explored
caregiver outcomes. Caregiver and program characteristics may be promising
avenues to target to decrease distress and burden during intervention design.
Interventions focusing on highly distressed caregivers may lead to greater
improvements. More research is needed to identify how site or interventionists
characteristics drive positive intervention effects.
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Affiliation(s)
- Megan Shepherd-Banigan
- Durham VA Health Care System, Durham, NC, USA.,Department of Population Health Sciences, Duke University, Durham, NC, USA.,Duke-Margolis Center for Health Policy, Durham, NC, USA
| | - Kelley A Jones
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Caitlin Sullivan
- Durham VA Health Care System, Durham, NC, USA.,Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Ke Wang
- Rosalynn Carter Institute for Caregivers, Georgia Southwestern State University, Americus, GA, USA
| | - Amy G Clark
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Courtney Van Houtven
- Durham VA Health Care System, Durham, NC, USA.,Department of Population Health Sciences, Duke University, Durham, NC, USA.,Duke-Margolis Center for Health Policy, Durham, NC, USA
| | - Jennifer M Olsen
- Rosalynn Carter Institute for Caregivers, Georgia Southwestern State University, Americus, GA, USA
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20
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Hill AV, Mistry S, Paglisotti TE, Dwarakanath N, Lavage DR, Hill AL, Iwuanyanwu R, Stokes LR, Jones KA, Miller E. Assessing feasibility of an adolescent relationship abuse prevention program for girls. J Adolesc 2022; 94:333-353. [PMID: 35390205 PMCID: PMC9009219 DOI: 10.1002/jad.12026] [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: 07/10/2020] [Accepted: 11/19/2021] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Sexual violence and relationship abuse are prevalent among adolescents and programs promoting gender equity, reproductive justice, and healthy relationships are key strategies for prevention. While such "gender transformative" approaches appear promising for boys, they have not been evaluated among girls. This study assessed the feasibility of this community-based program, called Sisterhood 2.0, among girls in socially disadvantaged urban neighborhoods in Pittsburgh, Pennsylvania. METHODS This quasi-experimental trial examined feasibility of Sisterhood 2.0 (n = 246), delivered through 8 weekly sessions, assessed through attendance, retention and satisfaction. Participants completed surveys at baseline and end of program assessing other relevant measures. Generalized linear mixed models estimated changes from baseline to follow up comparing intervention to control participants. RESULTS Eleven neighborhoods were assigned to Sisterhood 2.0 (n = 5 neighborhoods) or job-readiness training (n = 6 neighborhoods). Girls were between the ages of 13 and 19, 8-10th graders (59%), and self-identified as Black (69%). Participants most often attended because they thought the program would be interesting (74%) and returned because of the women teaching the program (71%). Girls reported experiences with physical adolescent relationship abuse (ARA) (30% in both arms), emotional ARA (66% intervention; 56% control), or sexual ARA (11% intervention; 12% control). Physical ARA perpetration was high in both arms (intervention: 47%; control: 46%). Significant intervention effects were observed in recognition of abuse (β = 0.41, 95% confidence interval 0.03-0.78). No other significant intervention effects were observed. CONCLUSIONS Community-based gender-transformative programming for girls is feasible and may be a promising approach for addressing interpersonal violence and promoting sexual health.
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Affiliation(s)
- Ashley V Hill
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Sejal Mistry
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - T E Paglisotti
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Namita Dwarakanath
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Daniel R Lavage
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Amber L Hill
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Rosemary Iwuanyanwu
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Lynissa R Stokes
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Kelley A Jones
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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21
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Jones KA, Small AD, Ray S, Hamilton DJ, Martin W, Robinson J, Goodfield NER, Paterson CA. Radionuclide ventriculography phase analysis for risk stratification of patients undergoing cardiotoxic cancer therapy. J Nucl Cardiol 2022; 29:581-589. [PMID: 32748278 PMCID: PMC8993717 DOI: 10.1007/s12350-020-02277-z] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 06/29/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Accurate diagnostic tools to identify patients at risk of cancer therapy-related cardiac dysfunction (CTRCD) are critical. For patients undergoing cardiotoxic cancer therapy, ejection fraction assessment using radionuclide ventriculography (RNVG) is commonly used for serial assessment of left ventricular (LV) function. METHODS In this retrospective study, approximate entropy (ApEn), synchrony, entropy, and standard deviation from the phase histogram (phase SD) were investigated as potential early markers of LV dysfunction to predict CTRCD. These phase parameters were calculated from the baseline RNVG phase image for 177 breast cancer patients before commencing cardiotoxic therapy. RESULTS Of the 177 patients, 11 had a decline in left ventricular ejection fraction (LVEF) of over 10% to an LVEF below 50% after treatment had commenced. This patient group had a significantly higher ApEn at baseline to those who maintained a normal LVEF throughout treatment. Of the parameters investigated, ApEn was superior for predicting the risk of CTRCD. Combining ApEn with the baseline LVEF further improved the discrimination between the groups. CONCLUSIONS The results suggest that RNVG phase analysis using approximate entropy may aid in the detection of sub-clinical LV contraction abnormalities, not detectable by baseline LVEF measurement, predicting a subsequent decline in LVEF.
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Affiliation(s)
- K A Jones
- Department of Nuclear Cardiology, Glasgow Royal Infirmary, Glasgow, UK.
- School of Physics and Astronomy, University of Glasgow, Glasgow, UK.
| | - A D Small
- Department of Nuclear Cardiology, Glasgow Royal Infirmary, Glasgow, UK
- School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
| | - S Ray
- School of Mathematics & Statistics, University of Glasgow, Glasgow, UK
| | - D J Hamilton
- School of Physics and Astronomy, University of Glasgow, Glasgow, UK
| | - W Martin
- Department of Nuclear Cardiology, Glasgow Royal Infirmary, Glasgow, UK
- School of Physics and Astronomy, University of Glasgow, Glasgow, UK
| | - J Robinson
- Department of Nuclear Cardiology, Glasgow Royal Infirmary, Glasgow, UK
- School of Physics and Astronomy, University of Glasgow, Glasgow, UK
| | - N E R Goodfield
- Department of Nuclear Cardiology, Glasgow Royal Infirmary, Glasgow, UK
| | - C A Paterson
- Department of Nuclear Cardiology, Glasgow Royal Infirmary, Glasgow, UK
- School of Physics and Astronomy, University of Glasgow, Glasgow, UK
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22
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Chugani CD, Jones KA, Coulter RW, Anderson JC, Talis J, Goldstein TR, Chung T, Miller E. Increased risk for binge drinking among college students with disability who report sexual violence. J Am Coll Health 2022; 70:691-697. [PMID: 32407169 PMCID: PMC7666107 DOI: 10.1080/07448481.2020.1760281] [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] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 04/19/2020] [Indexed: 06/11/2023]
Abstract
ObjectiveThis study investigated binge drinking in college students with and without disabilities and sexual violence (SV). Participants: This analysis includes 2,113 college students recruited from campus health or counseling centers between 2015 and 2017, aged 18-24. Method: Multinomial logistic regression procedures were used to estimate adjusted odds ratios (AOR) for past month binge drinking days (BDD). Results: Among students with disabilities, 68% endorsed SV, compared with 53% of those without disability. Disability was not significantly associated with BDD; SV was significantly associated with BDD (p < .0001). Students with SV, regardless of disability status, had 1.7- to 2.1-fold greater odds of having 4+ past month BDD. Conclusions: While disability alone is not a risk factor for binge drinking, novel findings include that students with disabilities binge drink at similarly high rates to their nondisabled peers, and are at elevated risk for SV, which is closely associated with binge drinking.
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Affiliation(s)
- Carla D. Chugani
- Division of Adolescent and Young Adult Medicine, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
- School of Medicine, Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kelley A. Jones
- Division of Adolescent and Young Adult Medicine, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
- School of Medicine, Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Robert W.S. Coulter
- Division of Adolescent and Young Adult Medicine, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
- School of Medicine, Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Graduate School of Public Health, Department of Behavioral and Communit Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jocelyn C. Anderson
- Division of Adolescent and Young Adult Medicine, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
- School of Medicine, Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Janine Talis
- School of Medicine, Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Tina R. Goldstein
- School of Medicine, Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Tammy Chung
- School of Medicine, Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
- School of Medicine, Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Ming DY, Jones KA, Sainz E, Tkach H, Stewart A, Cram A, Morreale MC, Dizon S, deJong NA. Feasibility of implementing systematic social needs assessment for children with medical complexity. Implement Sci Commun 2021; 2:130. [PMID: 34802465 PMCID: PMC8606226 DOI: 10.1186/s43058-021-00237-3] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 11/05/2021] [Indexed: 11/21/2022] Open
Abstract
Background Children with medical complexity (CMC) have inter-related health and social needs; however, interventions to identify and respond to social needs have not been adapted for CMC. The objective of this study was to evaluate the feasibility of implementing social needs screening and assessment within pediatric complex care programs. Methods We implemented systematic social needs assessment for CMC (SSNAC) at two tertiary care centers in three phases: (1) pre-implementation, (2) implementation, and (3) implementation monitoring. We utilized a multifaceted implementation package consisting of discrete implementation strategies within each phase. In phase 1, we adapted questions from evidence-informed screening tools into a 21-item SSNAC questionnaire, and we used published frameworks to inform implementation readiness and process. In phases 2–3, clinical staff deployed the SSNAC questionnaire to parents of CMC in-person or by phone as part of usual care and adapted to local clinical workflows. Staff used shared decision-making with parents and addressed identified needs by providing information about available resources, offering direct assistance, and making referrals to community agencies. Implementation outcomes included fidelity, feasibility, acceptability, and appropriateness. Results Observations from clinical staff characterized fidelity to use of the SSNAC questionnaire, assessment template, and shared decision-making for follow-up on unmet social needs. Levels of agreement (5-point Likert scale; 1 = completely disagree; 5 = completely agree) rated by staff for key implementation outcomes were moderate to high for acceptability (mean = 4.7; range = 3–5), feasibility (mean = 4.2; range = 3–5), and appropriateness (mean = 4.6; range = 4-5). 49 SSNAC questionnaires were completed with a 91% response rate. Among participating parents, 37 (76%) reported ≥ 1 social need, including food/nutrition benefits (41%), housing (18%), and caregiver needs (29%). Staff responses included information provision (41%), direct assistance (30%), and agency referral (30%). Conclusions It was feasible for tertiary care center-based pediatric complex care programs to implement a standardized social needs assessment for CMC to identify and address parent-reported unmet social needs. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-021-00237-3.
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Affiliation(s)
- David Y Ming
- Department of Pediatrics, DUMC, Duke University School of Medicine, Box 3352, Durham, NC, 27710, USA. .,Department of Medicine, Duke University School of Medicine, 2301 Erwin Rd, Durham, NC, 27710, USA. .,Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St, Durham, NC, 27701, USA.
| | - Kelley A Jones
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St, Durham, NC, 27701, USA
| | - Elizabeth Sainz
- Department of Pediatrics, DUMC, Duke University School of Medicine, Box 3352, Durham, NC, 27710, USA
| | - Heidie Tkach
- Department of Pediatrics, University of North Carolina School of Medicine, 260 MacNider Building, CB#7220, Chapel Hill, NC, 27599, USA
| | - Amy Stewart
- Department of Pediatrics, University of North Carolina School of Medicine, 260 MacNider Building, CB#7220, Chapel Hill, NC, 27599, USA
| | - Ashley Cram
- University of North Carolina School of Public Health, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
| | - Madlyn C Morreale
- Department of Pediatrics, University of North Carolina School of Medicine, 260 MacNider Building, CB#7220, Chapel Hill, NC, 27599, USA.,Legal Aid of North Carolina, 224 S. Dawson St, Raleigh, NC, 27601, USA
| | - Samantha Dizon
- Department of Pediatrics, DUMC, Duke University School of Medicine, Box 3352, Durham, NC, 27710, USA.,Department of Medicine, Duke University School of Medicine, 2301 Erwin Rd, Durham, NC, 27710, USA
| | - Neal A deJong
- Department of Pediatrics, University of North Carolina School of Medicine, 260 MacNider Building, CB#7220, Chapel Hill, NC, 27599, USA
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Chew DS, Jones KA, Loring Z, Black-Maier E, Noseworthy PA, Exner DV, Packer DL, Grant J, Mark DB, Piccini JP. Diagnosis-to-ablation time predicts recurrent atrial fibrillation and rehospitalization following catheter ablation. Heart Rhythm O2 2021; 3:23-31. [PMID: 35243432 PMCID: PMC8859793 DOI: 10.1016/j.hroo.2021.11.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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25
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Check DK, Winger JG, Jones KA, Somers TJ. Predictors of Response to an Evidence-Based Behavioral Cancer Pain Management Intervention: An Exploratory Analysis From a Clinical Trial. J Pain Symptom Manage 2021; 62:391-399. [PMID: 33387606 DOI: 10.1016/j.jpainsymman.2020.12.020] [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: 09/01/2020] [Revised: 12/03/2020] [Accepted: 12/24/2020] [Indexed: 10/22/2022]
Abstract
CONTEXT Interventions that teach patients cognitive and behavioral strategies for managing cancer pain have demonstrated effectiveness. Systematic reviews of such interventions call for research to inform their implementation in practice, including investigations into which patients are most likely to benefit. OBJECTIVES We aimed to identify predictors of response to an evidence-based behavioral intervention for cancer pain, pain coping skills training (PCST). METHODS We conducted an exploratory secondary analysis of a randomized noninferiority trial comparing in-person to videoconference-based PCST. Using modified Poisson regression, we estimated the adjusted associations of patient characteristics with clinically meaningful reductions (≥30%) in pain severity and pain interference. RESULTS Of the 178 patients who were randomized, 135 completed at least one follow-up assessment and were included in this analysis. Proportions of patients experiencing reductions in pain severity and pain interference were 34% and 46%, respectively. In multivariable analysis, education level was associated with a reduction in pain severity (adjusted relative risk, some college or technical school vs. college or higher: 0.49, 95% CI: 0.26-0.93). Patients with colorectal cancer were 61% more likely to experience a reduction in pain interference than patients with breast cancer (95% CI:1.21-2.34). Marital status was also statistically significantly associated with pain interference reduction, with married patients less likely to experience a reduction in pain interference (adjusted relative risk, married vs. not: 0.69, 95% CI: 0.49-0.98). CONCLUSION Our findings elucidate several subgroups of patients who may be especially likely to benefit from PCST, informing both targeted implementation efforts and opportunities to improve delivery for diverse patients.
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Affiliation(s)
- Devon K Check
- Department of Population Health Sciences, Duke University School of Medicine, Duke Cancer Institute, Durham, North Carolina, USA.
| | - Joseph G Winger
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kelley A Jones
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Tamara J Somers
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Duke Cancer Institute, Durham, North Carolina, USA
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Chugani CD, Anderson JC, Richter RK, Bonomi AE, DeGenna NM, Feinstein Z, Jones KA, Miller E. Perceptions of College Campus Alcohol and Sexual Violence Prevention Among Students with Disabilities: "It Was A Joke". J Fam Violence 2021; 36:281-291. [PMID: 34083871 PMCID: PMC8168969 DOI: 10.1007/s10896-020-00150-8] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE The purpose of this study was to understand perceptions of campus-based alcohol and sexual violence (SV) prevention programming among college students with disabilities to inform future development of prevention programs appropriate for the needs of these students. METHOD The study included semi-structured, qualitative interviews with 51 college students with disabilities who reported histories of SV recruited from a larger parent study investigating a brief universal intervention to reduce alcohol related SV involving 28 campuses across Western Pennsylvania and West Virginia. Interviews focused on college-related experiences of prevention programming, and experiences of health, disability, alcohol use and violence victimization. Data were analyzed using thematic analysis. RESULTS Three themes emerged: (1) Students with disabilities described campus prevention programming as ineffective and irrelevant to their experiences, including referring to programs as "a joke," (2) Students wanted multi-dose, developmentally relevant content that directly addresses the complexities of their experiences with disability, alcohol, and violence, and (3) Students called for programing focused on engaging their interests. CONCLUSIONS Our results point to the need to augment campus-based programming, with attention to the unique needs and relevant concerns of students with disabilities, within the broader context of campus prevention programming.
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Affiliation(s)
- Carla D Chugani
- Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine
| | | | - Rachael K Richter
- Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine
| | - Amy E Bonomi
- Children and Youth Institute, Michigan State University
| | - Natacha M DeGenna
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Zoe Feinstein
- Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine
| | - Kelley A Jones
- Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine
| | - Elizabeth Miller
- Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine
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Jones KA, Tancredi DJ, Abebe KZ, Paglisotti T, Miller E. Cases of Sexual Assault Prevented in an Athletic Coach-Delivered Gender Violence Prevention Program. Prev Sci 2021; 22:504-508. [PMID: 33481150 DOI: 10.1007/s11121-021-01210-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2021] [Indexed: 10/22/2022]
Abstract
Sexual violence (SV) is pervasive and economically burdensome in the USA. According to the CDC, SV prevention could avert $122,461 in costs per victim of rape, totaling an estimated $3.1 trillion. Coaching Boys into Men (CBIM) is an evidence-based dating abuse and SV prevention program found to reduce dating abuse and SV perpetration among male high school athletes and dating abuse among middle school athletes. This secondary data analysis of CBIM's high school (N = 1520) and middle school (N = 973) RCTs estimated the incidence of dating abuse, sexual harassment, and sexual assault that CBIM could prevent as well as the potential cost savings. Ten items measured dating abuse, with a subset measuring sexual assault and sexual harassment, among participants who had ever dated a female. Perpetration measures were dichotomized as present or absent. Maximum likelihood estimates of Poisson-distributed event rates allowed for possible multiple incidents of perpetration per athlete. Among high school athletes, CBIM was associated with a relative reduction of 85 incidents of dating abuse (95%CI 24, 146), 48 incidents of sexual harassment (95%CI 3.8, 92), and 20 incidents of sexual assault (95%CI 1.7, 38) per 1,000 athletes. Results among middle school athletes demonstrated similar, albeit non-significant, trends. Based on the reduction of sexual assaults among high school athletes alone, CBIM may have resulted in $2.4 million reduction in costs per 1000 athletes exposed. CBIM may be associated with significant sexual assault-related cost reductions. Given the low costs and time needed to implement the program, sexual and dating violence prevention programs like CBIM may result in substantial economic benefits.
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Affiliation(s)
- Kelley A Jones
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, 120 Lytton Avenue, Suite 302, Pittsburgh, PA, 15213, USA. .,Department of Population Health Sciences, Duke University School of Medicine, 115 Morris Street, Durham, NC, 27701, USA.
| | - Daniel J Tancredi
- Department of Pediatrics and Center for Healthcare Policy and Research, University of California, 2103 Stockton Boulevard, Suite 2224, DavisSacramento, CA, 95817, USA
| | - Kaleab Z Abebe
- Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, 200 Meyran Avenue, Suite 300, Pittsburgh, PA, 15213, USA
| | - Taylor Paglisotti
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, 120 Lytton Avenue, Suite 302, Pittsburgh, PA, 15213, USA
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, 120 Lytton Avenue, Suite 302, Pittsburgh, PA, 15213, USA
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Miller E, Jones KA, Culyba AJ, Paglisotti T, Dwarakanath N, Massof M, Feinstein Z, Ports KA, Espelage D, Pulerwitz J, Garg A, Kato-Wallace J, Abebe KZ. Effect of a Community-Based Gender Norms Program on Sexual Violence Perpetration by Adolescent Boys and Young Men: A Cluster Randomized Clinical Trial. JAMA Netw Open 2020; 3:e2028499. [PMID: 33351083 PMCID: PMC7756236 DOI: 10.1001/jamanetworkopen.2020.28499] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
IMPORTANCE Engaging adolescent boys and young men in preventing violence against women is a potentially impactful public health strategy. OBJECTIVE To evaluate the effectiveness of a community-based, gender-transformative program (ie, Manhood 2.0) on perpetration of gender-based violence by adolescent boys and young men. DESIGN, SETTING, AND PARTICIPANTS In this unblinded cluster randomized clinical trial, neighborhoods were designated as the unit of clustering (1:1 allocation). Three-month (ie, time point 2 [T2]) and 9-month (ie, time point 3 [T3]) follow-ups were conducted. The trial took place in 20 Pittsburgh, Pennsylvania, neighborhoods and 1 centrally located site with concentrated disadvantage. Pittsburgh-based adolescent boys and young men (ages 13 to 19 years) were recruited between July 27, 2015, and June 5, 2017, through youth-serving organizations and community-based alternatives to residential placement for juvenile justice-involved youth. Intention-to-treat analysis was conducted from June 2018 to November 2019. INTERVENTIONS Manhood 2.0, an international program adapted for adolescent boys and young men in US urban communities, encourages these individuals to challenge gender norms that foster violence against women and unhealthy sexual relationships. Individuals in the control population received job-readiness training. Each program was 18 hours. MAIN OUTCOMES AND MEASURES The primary outcome was change in participant-level perpetration of sexual violence (SV) or adolescent relationship abuse (ARA) at T3. RESULTS Among 866 participants, 465 individuals (54%) enrolled in 11 intervention clusters and 401 individuals (46%) enrolled in 10 control clusters. In the intervention group, 325 participants (70%) were analyzed at T2 and 334 participants (72%) were analyzed at T3; in the control group, 262 participants (65%) were analyzed at T2 and 301 participants (75%) were analyzed at T3. Mean (SD) age was 15.5 (1.6) years; 609 participants (70%) self-identified as non-Hispanic Black, and 178 (20%) self-identified as Hispanic, multiracial, or other race/ethnicity other than White. Among individuals in the intervention group, 296 participants (64%) reported any SV or ARA perpetration at baseline, and 173 participants (52%) reported any SV or ARA perpetration at T3. Among individuals in the control group, 213 participants (53%) reported any SV or ARA perpetration at baseline, and 124 participants (41%) reported any SV or ARA perpetration at T3). The difference in reduction between groups was not significant. There was no evidence of an intervention effect for the primary outcome (adjusted odds ratio [OR], 1.32; 95% CI, 0.86-2.01; P = .20). CONCLUSIONS AND RELEVANCE The findings from this evaluation of a community-based gender-transformative program for adolescent boys and young men did not show a significant intervention effect in reducing SV or ARA perpetration between Manhood 2.0 and a job-readiness control program. Combining gender-transformative approaches with job-readiness programs may be relevant for violence prevention in low-resource urban settings. Attention to improving implementation and strategies to sustain such community-based efforts are needed. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02427061.
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Affiliation(s)
- Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Kelley A. Jones
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Alison J. Culyba
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Taylor Paglisotti
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Namita Dwarakanath
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Michael Massof
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Zoe Feinstein
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Katie A. Ports
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Dorothy Espelage
- University of North Carolina at Chapel Hill School of Education, Chapel Hill
| | | | - Aapta Garg
- Promundo-US, Washington, District of Columbia
| | | | - Kaleab Z. Abebe
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Hill AL, Zachor H, Miller E, Talis J, Zelazny S, Jones KA. Trauma-Informed Personalized Scripts to Address Partner Violence and Reproductive Coercion: Follow-Up Findings from an Implementation Randomized Controlled Trial Study. J Womens Health (Larchmt) 2020; 30:604-614. [PMID: 33211607 DOI: 10.1089/jwh.2020.8527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Intimate partner violence (IPV) and reproductive coercion impact women seeking care at family planning (FP) clinics. Interventions to facilitate patient-provider conversations about healthy relationships are needed. We sought to determine the added effect of providing psychoeducational messages to patients compared with tailored provider scripts alone on sexual and reproductive health outcomes at 4-6 months. Materials and Methods: We randomized participants to Trauma-Informed Personalized Scripts (TIPS)-Plus (provider scripts +patient messages) or TIPS-Basic (provider scripts only) at four FP clinics. Eligible patients included English-speaking females aged 16-29 years. Data were collected at initial visits (T1) and 4-6 months (T2) on IPV, reproductive coercion, fear, condom and other contraceptive use, self-efficacy, harm reduction behaviors, and knowledge/use of IPV-related services. We compared frequencies and summary scores between baseline and follow-up with McNemar's test of paired proportions and Signed Rank-Sum, respectively. We compared the difference in differences over time by treatment arm using two-sample t-tests, and used linear, logistic, and ordinal logistic regression to compare intervention effects at follow-up. Results: Two hundred forty patients participated (114 TIPS-Plus, 126 TIPS-Basic), 216 completed follow-up. We detected no differences in outcomes between treatment arms. Between T1 and T2, we observed overall reductions in mean summary scores for reproductive coercion (T1 = 0.08 ± 0.02, T2 = 0.02 ± 0.01, p = 0.028) and increases in contraceptive use (69.6%-87.9%, p < 0.001), long-acting reversible contraceptives (8.3%-20.8%, p < 0.001), and hidden methods (20%-38.5%, p < 0.001). Conclusions: We show no added benefit of patient-activation messages compared with provider scripts alone. Findings suggest potential utility of provider scripts in addressing reproductive coercion and contraceptive uptake (Trial Registration No. NCT02782728).
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Affiliation(s)
- Amber L Hill
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Hadas Zachor
- Department of Psychiatry and Behavioral Science, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Janine Talis
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | | | - Kelley A Jones
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Shepherd-Banigan M, Jones KA, Wang K, DePasquale N, Van Houtven C, Olsen JM. Mechanisms Through Which a Family Caregiver Coaching Intervention Might Reduce Anxiety Among Children in Military Households. Matern Child Health J 2020; 24:1248-1258. [PMID: 32749616 DOI: 10.1007/s10995-020-02964-w] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Children of injured or disabled veterans and service members may be at risk for mental health and adjustment problems due to household stress. Yet, there are few widely available interventions to address the needs of this population. Reducing distress and improving coping skills of the parent who cares for the injured or disabled adult may improve child outcomes. This paper examines whether changes in caregiver psychosocial outcomes after a caregiver coaching intervention are associated with decreases in child anxiety. METHODS Using programmatic data collected between 2015 and 2019 from participants in a family caregiver coaching intervention (170 caregivers, 294 children), we apply linear mixed models to assess associations between changes in family caregiver well-being, including problem solving, depressive symptoms, burden, health complaints and quality of life, and changes in parent-reported child anxiety. RESULTS The baseline median Spence Children's Anxiety Scale-Parent score was 17; children aged 6-11 had slightly higher scores. Child anxiety scores decreased on average 2.8 points (SD 8.4) between baseline and follow-up. In adjusted models, decreases in caregiver depressive symptoms and health complaints were associated with decreases in child anxiety. Caregiver problem-solving skills, quality of life, and subjective burden were not associated with changes in child anxiety. CONCLUSION Family caregiver-focused interventions that decrease caregiver stress may positively affect children in the household. Few resources are directed at military children; therefore, practitioners should consider ways to leverage caregiver interventions to address child well-being, such as incorporating information on parenting strategies and addressing issues faced by military children.
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Affiliation(s)
- Megan Shepherd-Banigan
- Durham VA Health Care System, 508 Fulton Street, Durham, NC, 27705, USA.
- Department of Population Health Sciences, Duke University, 215 Morris Street, Durham, NC, 27701, USA.
| | - Kelley A Jones
- Department of Population Health Sciences, Duke University, 215 Morris Street, Durham, NC, 27701, USA
| | - Ke Wang
- Rosalynn Carter Institute for Caregiving, Georgia Southwestern State University, 800 GSW State University Drive, Americus, GA, 31709, USA
| | - Nicole DePasquale
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, 200 Morris Street, Durham, NC, 27701, USA
| | - Courtney Van Houtven
- Durham VA Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University, 215 Morris Street, Durham, NC, 27701, USA
- Duke-Margolis Center for Health Policy, 100 Fuqua Drive, Box 90120, Durham, NC, 27708, USA
| | - Jennifer M Olsen
- Rosalynn Carter Institute for Caregiving, Georgia Southwestern State University, 800 GSW State University Drive, Americus, GA, 31709, USA
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Anderson JC, Chugani CD, Jones KA, Coulter RWS, Chung T, Miller E. Characteristics of precollege sexual violence victimization and associations with sexual violence revictimization during college. J Am Coll Health 2020; 68:509-517. [PMID: 30908164 PMCID: PMC6761049 DOI: 10.1080/07448481.2019.1583237] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 12/21/2018] [Accepted: 02/08/2019] [Indexed: 05/30/2023]
Abstract
Objective: To examine the prevalence and characteristics of precollege sexual victimization (SV) experiences and associations with revictimization and recent substance use behaviors among a sample of college students who reported precollege SV. Participants: A sub-sample of 931 college students who reported precollege SV at baseline data collection for an ongoing multi-site clinical trial. Methods: Data were collected via electronic surveys between September 2015 and March 2017. Measures included precollege and during college SV, recent substance use, and alcohol-related harm reduction behaviors. Results: Precollege SV characteristics associated with revictimization included: Nonpenile penetration (aOR: 1.51, 95%CI: 1.04-2.19); pressured sex (aOR: 1.46, 95%CI: 1.06-2.01); and stranger assault (aOR: 2.03, 95%CI: 1.22-3.40). Past 30-day binge drinking was also associated with revictimization (aOR: 1.86, 95%CI: 1.36-2.54). Conclusions: The relationship between precollege SV and alcohol, especially binge drinking, may require a more integrated approach to preventing subsequent revictimization.
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Affiliation(s)
- Jocelyn C. Anderson
- Pennsylvania State University, College of Nursing
- University of Pittsburgh School of Medicine, Department of Pediatrics
| | - Carla D. Chugani
- University of Pittsburgh School of Medicine, Department of Pediatrics
| | - Kelley A. Jones
- University of Pittsburgh School of Medicine, Department of Pediatrics
| | | | - Tammy Chung
- University of Pittsburgh School of Medicine, Department of Psychiatry
| | - Elizabeth Miller
- University of Pittsburgh School of Medicine, Department of Pediatrics
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Miller E, Jones KA, McCauley HL, Rofey DL, Clark DB, Talis JM, Anderson JC, Chugani CD, Coulter RWS, Abebe KZ. Cluster Randomized Trial of a College Health Center Sexual Violence Intervention. Am J Prev Med 2020; 59:98-108. [PMID: 32362510 PMCID: PMC7360347 DOI: 10.1016/j.amepre.2020.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 02/09/2020] [Accepted: 02/10/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Sexual violence, particularly in the context of drinking, is prevalent on college campuses. This study tested a brief intervention to prevent sexual violence among students receiving care from college health centers. STUDY DESIGN This study was a two-arm, unblinded cluster RCT. SETTING/PARTICIPANTS On 28 campuses with health/counseling centers (1:1 randomization allocation; 12 intervention and 16 control), from September 2015 to March 2018, a total of 2,291 students seeking care at college health centers completed surveys before the appointment, immediately after, 4 months later, and 12 months later. INTERVENTION Intervention college health center staff received training on delivering sexual violence education to all students seeking care. Control sites provided information about drinking responsibly. MAIN OUTCOME MEASURES The primary outcome was students' change in recognition of sexual violence. Additional outcomes included sexual violence disclosure and use of services among students with a history of sexual violence at baseline. Generalized linear mixed models accounting for campus-level clustering assessed intervention effects. Data were analyzed from September 2018 to June 2019. RESULTS Half (55%) of students seeking care at college health centers reported any history of sexual violence exposure. No between-group differences in primary (β=0.001, 95% CI= -0.04, 0.04) or secondary outcomes emerged between intervention and control students. Post-hoc analyses adjusting for the intensity of intervention delivery (intensity-adjusted) revealed an increase in self-efficacy to use harm reduction strategies (β=0.09, 95% CI=0.01, 0.18) among intervention participants. Among those who reported sexual violence at baseline, intervention students had increased odds of disclosing violence during the visit (AOR=4.47, 95% CI=2.25, 8.89) in intensity-adjusted analyses compared with control. No between-group differences emerged for remaining outcomes. CONCLUSIONS Sexual violence exposure is high among students seeking care in college health centers. A brief provider-delivered sexual violence intervention, when implemented with fidelity, was associated with improved self-efficacy to use harm reduction and increased disclosure of sexual violence during clinical encounters but no increased use of services. More interventions that are stronger in intensity are needed to connect students to sexual violence services. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT02355470.
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Affiliation(s)
- Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
| | - Kelley A Jones
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Heather L McCauley
- School of Social Work, Michigan State University, East Lansing, Michigan
| | - Dana L Rofey
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Psychiatry, Western Psychiatric Hospital, Pittsburgh, Pennsylvania
| | - Duncan B Clark
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Janine M Talis
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jocelyn C Anderson
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; College of Nursing, Pennsylvania State University, State College, Pennsylvania
| | - Carla D Chugani
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Robert W S Coulter
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kaleab Z Abebe
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Giho Y, Jones KA, Dick RN, Gold MA, Talis JM, Gmelin TA, Laird HJ, Vanek MS, Miller E. Feasibility and acceptability of using a web-based contraceptive support tool in a university health clinic. J Am Coll Health 2020; 68:336-340. [PMID: 30908150 DOI: 10.1080/07448481.2019.1577859] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 11/07/2018] [Accepted: 01/29/2019] [Indexed: 06/09/2023]
Abstract
Objective: To evaluate feasibility of integrating Bedsider.org, a web-based contraceptive decision support tool, at a university health clinic (UHC). Participants: Female students (ages 18-29) seeking contraceptive care at the UHC were enrolled in September 2015 (n = 46). Methods: Providers recruited eligible patients during reproductive healthcare visits and introduced Bedsider. Surveys were administered immediately following the visit and a follow-up 2-4 weeks later. Electronic health records through 6 weeks post-enrollment were extracted. Results: Most patients had positive views toward Bedsider and appreciated receiving information during their UHC encounters. None were using long-acting reversible contraceptives (LARC) at enrollment. At follow-up, two patients self-reported IUD use. Among those recently sexually active, use of more effective contraceptive methods increased from 65% to 74%; 11% had initiated or were scheduled to receive a LARC. Conclusion: Bedsider can be feasibly integrated into UHC visits and may support women's selection of more effective contraceptive methods, including LARCs.
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Affiliation(s)
- Yukiko Giho
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- University of Pittsburgh Student Health Service, Pittsburgh, Pennsylvania, USA
| | - Kelley A Jones
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Rebecca N Dick
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Melanie A Gold
- Department of Pediatrics, Division of Child and Adolescent Health, Columbia University Medical Center, New York, New York, USA
- dDepartment of Population and Family Health, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Janine M Talis
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Theresa A Gmelin
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Hollis J Laird
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Marian S Vanek
- University of Pittsburgh Student Health Service, Pittsburgh, Pennsylvania, USA
| | - Elizabeth Miller
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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McCauley HL, Jones KA, Rofey DL, Reid TA, Miller E, Coulter RWS. Sexual Assault, Alcohol Use, and Gender of Sexual Partners Among Cisgender Women Seeking Care at US College Health Centers, 2015-2018. Am J Public Health 2020; 110:850-856. [PMID: 32298176 DOI: 10.2105/ajph.2020.305586] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To assess differences by gender of sexual partner in the association between sexual assault and alcohol use among women seeking care in college health centers.Methods. This longitudinal study comprised 1578 women aged 18 to 24 years visiting 28 college health centers in Pennsylvania and West Virginia from 2015 to 2018. We used multilevel logistic regression and negative binomial regression, testing for interactions of gender of sexual partners, sexual assault, and prevalence and frequency of alcohol use and binge drinking.Results. Sexual assault was reported by 87.3% of women who had sex with women or with women and men (WSWM), 68.2% of women who had sex with men only (WSM), and 47.5% of women with no penetrative sexual partners. The relative associations between sexual assault and alcohol outcomes were smaller for WSWM (prevalence: odds ratios from 0.04 to 0.06; frequency: incidence rate ratios [IRRs] from 0.24 to 0.43) and larger for women who had no penetrative sexual partners (IRRs from 1.55 to 2.63), compared with WSM.Conclusions. Alcohol use patterns among women who have experienced sexual assault differ by gender of sexual partners.
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Affiliation(s)
- Heather L McCauley
- Heather L. McCauley is with the School of Social Work and Taylor A. Reid is with the Department of Human Development and Family Studies at Michigan State University, East Lansing. Kelley A. Jones and Elizabeth Miller are with the Department of Pediatrics and Dana L. Rofey is with the Department of Psychiatry at University of Pittsburgh School of Medicine, Pittsburgh, PA. Robert W. S. Coulter is with the Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh
| | - Kelley A Jones
- Heather L. McCauley is with the School of Social Work and Taylor A. Reid is with the Department of Human Development and Family Studies at Michigan State University, East Lansing. Kelley A. Jones and Elizabeth Miller are with the Department of Pediatrics and Dana L. Rofey is with the Department of Psychiatry at University of Pittsburgh School of Medicine, Pittsburgh, PA. Robert W. S. Coulter is with the Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh
| | - Dana L Rofey
- Heather L. McCauley is with the School of Social Work and Taylor A. Reid is with the Department of Human Development and Family Studies at Michigan State University, East Lansing. Kelley A. Jones and Elizabeth Miller are with the Department of Pediatrics and Dana L. Rofey is with the Department of Psychiatry at University of Pittsburgh School of Medicine, Pittsburgh, PA. Robert W. S. Coulter is with the Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh
| | - Taylor A Reid
- Heather L. McCauley is with the School of Social Work and Taylor A. Reid is with the Department of Human Development and Family Studies at Michigan State University, East Lansing. Kelley A. Jones and Elizabeth Miller are with the Department of Pediatrics and Dana L. Rofey is with the Department of Psychiatry at University of Pittsburgh School of Medicine, Pittsburgh, PA. Robert W. S. Coulter is with the Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh
| | - Elizabeth Miller
- Heather L. McCauley is with the School of Social Work and Taylor A. Reid is with the Department of Human Development and Family Studies at Michigan State University, East Lansing. Kelley A. Jones and Elizabeth Miller are with the Department of Pediatrics and Dana L. Rofey is with the Department of Psychiatry at University of Pittsburgh School of Medicine, Pittsburgh, PA. Robert W. S. Coulter is with the Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh
| | - Robert W S Coulter
- Heather L. McCauley is with the School of Social Work and Taylor A. Reid is with the Department of Human Development and Family Studies at Michigan State University, East Lansing. Kelley A. Jones and Elizabeth Miller are with the Department of Pediatrics and Dana L. Rofey is with the Department of Psychiatry at University of Pittsburgh School of Medicine, Pittsburgh, PA. Robert W. S. Coulter is with the Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh
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Miller E, Jones KA, Ripper L, Paglisotti T, Mulbah P, Abebe KZ. An Athletic Coach-Delivered Middle School Gender Violence Prevention Program: A Cluster Randomized Clinical Trial. JAMA Pediatr 2020; 174:241-249. [PMID: 31930358 PMCID: PMC6990799 DOI: 10.1001/jamapediatrics.2019.5217] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Adolescent relationship abuse (ARA) and sexual violence (SV) reported among adolescents point to the need for prevention among middle school-age youths. OBJECTIVE To test an athletic coach-delivered relationship abuse and sexual violence prevention program among middle school male athletes. DESIGN, SETTING, AND PARTICIPANTS An unblinded cluster randomized clinical trial from spring 2015 to fall 2017 at 41 middle schools (38 clusters). The study included 973 male middle school athletes (ages 11-14 years; grades 6-8; participation rate 50%) followed up for 1 year (retention 86%). INTERVENTIONS Coaching Boys Into Men (CBIM) is a prevention program that trains athletic coaches to talk to male athletes about (1) respectful relationship behaviors, (2) promoting more gender-equitable attitudes, and (3) positive bystander intervention when harmful behaviors among peers are witnessed. MAIN OUTCOMES AND MEASURES The primary outcome was change in positive bystander behaviors (ie, intervening in peers' disrespectful or harmful behaviors); secondary outcomes were changes in recognition of what constitutes abusive behavior, intentions to intervene, gender-equitable attitudes, and reduction in recent ARA/SV perpetration (at end of sports season and 1-year follow up). RESULTS Of the 973 participants, 530 were white (54.5%), 282 were black (29.0%), 14 were Hispanic (1.4%), and the remainder were multiracial, other race/ethnicity, or not reported. Positive bystander behaviors increased at end of sports season and at 1-year follow-up (relative risk, 1.51; 95% CI, 1.06-2.16 and 1.53; 95% CI, 1.10-2.12, respectively) as did recognition of abuse (mean risk difference, 0.14; 95% CI, 0.01-0.27 and 0.14; 95% CI, 0.00-0.28, respectively). At 1-year follow-up, among those who ever dated, athletes on teams receiving CBIM had lower odds of reporting recent ARA/SV perpetration (odds ratio, 0.24; 95% CI, 0.09-0.65). Gender attitudes and intentions to intervene did not differ between study arms. In exploratory intensity-adjusted and per protocol analyses, athletes on teams receiving CBIM were more likely to report positive bystander behaviors and to endorse equitable gender attitudes and less likely to report ARA and sexual harassment perpetration 1 year later. CONCLUSIONS AND RELEVANCE An athletic coach-delivered program for middle school male athletes is an effective strategy for reducing relationship abuse among younger adolescents. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02331238.
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Affiliation(s)
- Elizabeth Miller
- UPMC Children’s Hospital of Pittsburgh, Division of Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Kelley A. Jones
- UPMC Children’s Hospital of Pittsburgh, Division of Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Lisa Ripper
- UPMC Children’s Hospital of Pittsburgh, Division of Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Taylor Paglisotti
- UPMC Children’s Hospital of Pittsburgh, Division of Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Paul Mulbah
- UPMC Children’s Hospital of Pittsburgh, Division of Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Kaleab Z. Abebe
- Division of General Internal Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania
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Miller E, Culyba AJ, Paglisotti T, Massof M, Gao Q, Ports KA, Kato-Wallace J, Pulerwitz J, Espelage DL, Abebe KZ, Jones KA. Male Adolescents' Gender Attitudes and Violence: Implications for Youth Violence Prevention. Am J Prev Med 2020; 58:396-406. [PMID: 31889621 PMCID: PMC7039734 DOI: 10.1016/j.amepre.2019.10.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 07/19/2019] [Revised: 10/20/2019] [Accepted: 10/21/2019] [Indexed: 12/28/2022]
Abstract
INTRODUCTION This study analyzed the associations among male adolescents' gender attitudes, intentions to intervene, witnessing peers' abusive behaviors, and multiple forms of adolescent violence perpetration. This community-based evaluation aims to inform future youth violence prevention efforts through the identification of potential predictors of interpersonal violence perpetration. METHODS Cross-sectional data were from baseline surveys conducted with 866 male adolescents, aged 13-19 years, from community settings in 20 lower-resource neighborhoods in Pittsburgh, PA (August 2015 - June 2017), as part of a cluster RCT to evaluate a sexual violence prevention program. Participants completed in-person, anonymous electronic surveys about gender attitudes, bystander intentions, witnessing peers' abusive behaviors, violence perpetration, and demographics. The analysis was conducted between 2018 and 2019. RESULTS The youth identified mostly as African American (70%) or Hispanic, multiracial, or other (21%). Most (88%) were born in the U.S., and 85% were in school. Youth with more equitable gender attitudes had lower odds of self-reported violence perpetration across multiple domains, including dating abuse (AOR=0.46, 95% CI=0.29, 0.72) and sexual harassment (AOR=0.50, 95% CI=0.37, 0.67). The relationship between intentions to intervene and violence perpetration was inconclusive. Witnessing peers engaged in abusive behaviors was associated with increased odds of multiple types of violence perpetration, such as dating abuse (witnessed 3 or more behaviors, AOR=2.41, 95% CI=1.31, 4.44). CONCLUSIONS This is the first U.S.-based study to elicit information from male adolescents in community-based settings (rather than schools or clinics) about multiple types of interpersonal violence perpetration. Findings support violence prevention strategies that challenge harmful gender and social norms while simultaneously increasing youths' skills in interrupting peers' disrespectful and harmful behaviors.
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Affiliation(s)
- Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
| | - Alison J Culyba
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Taylor Paglisotti
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Michael Massof
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Qi Gao
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Katie A Ports
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Julie Pulerwitz
- HIV and AIDS Program, Population Council, Washington, District of Columbia
| | - Dorothy L Espelage
- School of Education, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kaleab Z Abebe
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Kelley A Jones
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Muiruri C, Sico IP, Schexnayder J, Webel AR, Okeke NL, Longenecker CT, Gonzalez JM, Jones KA, Gonzales SE, Bosworth HB. Why Do People Living with HIV Adhere to Antiretroviral Therapy and Not Comorbid Cardiovascular Disease Medications? A Qualitative Inquiry. Patient Prefer Adherence 2020; 14:985-994. [PMID: 32669837 PMCID: PMC7337208 DOI: 10.2147/ppa.s254882] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 05/19/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND After achieving viral suppression, it is critical for persons living with HIV (PLWH) to focus on prevention of non-AIDS comorbidities such as cardiovascular disease (CVD) in order to enhance their quality of life and longevity of life. Despite PLWH elevated risk of developing CVD compared to individuals without HIV, PLWH do not often meet evidence-based treatment goals for CVD prevention; the reasons for PLWH not meeting guideline recommendations are poorly understood. The objective of this study was to identify the factors associated with adherence to CVD medications for PLWH who have achieved viral suppression. METHODS Qualitative data were obtained from formative research conducted to inform the adaptation of a nurse-led intervention trial to improve cardiovascular health at three large academic medical centers in the United States. Transcripts were analyzed using content analysis guided by principles drawn from grounded theory. RESULTS Fifty-one individuals who had achieved viral suppression (<200 copies/mL) participated: 37 in 6 focus groups and 14 in individual semi-structured interviews. Mean age was 57 years (SD: 7.8); most were African Americans (n=31) and majority were male (n=34). Three main themes were observed. First, participants reported discordance between their healthcare providers' recommendations and their own preferred strategies to reduce CVD risk. Second, participants intentionally modified frequency of CVD medication taking which appeared to be related to low CVD risk perception and perceived or experienced side effects with treatment. Finally, participants discussed the impact of long-term experience with HIV care on adherence to CVD medication and motivational factors that enhanced adherence to heart healthy behaviors. CONCLUSION Findings suggest that future research should focus on developing interventions to enhance patient-provider communication in order to elicit beliefs, concerns and preferences for CVD prevention strategies. Future research should seek to leverage and adapt established evidence-based practices in HIV care to support CVD medication adherence.
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Affiliation(s)
- Charles Muiruri
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Correspondence: Charles Muiruri Email
| | - Isabelle P Sico
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Julie Schexnayder
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Allison R Webel
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | | | | | - Juan Marcos Gonzalez
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Kelley A Jones
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Sarah E Gonzales
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Hayden B Bosworth
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
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Close AG, Jones KA, Landowski A, Switzer GE, Kazmerski TM, Miller E, Friehling E. Current practices in menstrual management in adolescents with cancer: A national survey of pediatric oncology providers. Pediatr Blood Cancer 2019; 66:e27961. [PMID: 31441217 DOI: 10.1002/pbc.27961] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 06/23/2019] [Accepted: 07/14/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Adolescents and young adult (AYA) women with cancer are at risk of heavy menstrual bleeding (HMB) due to thrombocytopenia, coagulopathy, and/or disruption of the hypothalamic-pituitary-gonadal axis. Currently, little is known about current practices to help prevent and treat HMB in AYA women with cancer. METHODS We surveyed providers from 100 pediatric oncology centers. Face and content validity were assessed prior to distribution. Descriptive statistics, Chi-squared and Fisher exact tests were used for analysis. RESULTS Ninety-four percent of respondents have recommended preventative menstrual suppression. More than half of respondents agreed that patients with the following types of cancers should receive preventative menstrual suppression: sarcomas, acute leukemias, lymphomas, and germ cell tumors. The most preferred form of menstrual suppression was GnRH agonists. Almost 95% of respondents felt that it is important to consider menstrual suppression and that a formal guideline about initiation of menstrual suppression would be helpful. Only 46% felt comfortable personally managing menstrual suppression. CONCLUSIONS The vast majority of pediatric oncologists who responded to this national survey have used preventative menstrual suppression and feel that it is important to consider in many types of AYA cancers. Although pediatric oncologists are most often managing menstrual suppression, they do not feel comfortable doing so and desire guidelines to help with management. Future studies to assess which patients require menstrual suppression and which menstrual suppression is best tolerated and efficacious is needed.
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Affiliation(s)
- Allison G Close
- Department of Pediatrics, Division of Hematology/Oncology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kelley A Jones
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Allison Landowski
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Galen E Switzer
- Departments of Medicine, Psychiatry, Clinical and Translational Science, University of Pittsburgh, Pittsburgh, Pennsylvania.,Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Traci M Kazmerski
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.,Center for Women's Health Research and Innovation (CWHRI), University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Elizabeth Miller
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.,Center for Women's Health Research and Innovation (CWHRI), University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Erika Friehling
- Department of Pediatrics, Division of Hematology/Oncology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
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Hill AL, Zachor H, Jones KA, Talis J, Zelazny S, Miller E. Trauma-Informed Personalized Scripts to Address Partner Violence and Reproductive Coercion: Preliminary Findings from an Implementation Randomized Controlled Trial. J Womens Health (Larchmt) 2019; 28:863-873. [PMID: 30969147 DOI: 10.1089/jwh.2018.7318] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Family planning (FP) providers are in an optimal position to address harmful partner behaviors, yet face several barriers. We assessed the effectiveness of an interactive app to facilitate implementation of patient-provider discussions about intimate partner violence (IPV), reproductive coercion (RC), a wallet-sized educational card, and sexually transmitted infections (STIs). Materials and Methods: We randomized participants (English-speaking females, ages 16-29 years) from four FP clinics to two arms: Trauma-Informed Personalized Scripts (TIPS)-Plus and TIPS-Basic. We developed an app that prompted (1) tailored provider scripts (TIPS-Plus and TIPS-Basic) and (2) psychoeducational messages for patients (TIPS-Plus only). Patients completed pre- and postvisit surveys. We compared mean summary scores of IPV, RC, card, and STI discussions between TIPS-Plus and TIPS-Basic using Wilcoxon rank-sum tests, explored predictors with ordinal regression, and compared implementation with historical data using chi-square. Results: Of the 240 participants, 47.5% reported lifetime IPV, 12.5% recent IPV, and 7.1% recent RC. No statistically significant differences emerged from summary scores between arms for any outcomes. Several significant predictors were associated with higher scores for patient-provider discussions, including race, reason for visit, contraceptive method, and condom nonuse. Implementation of IPV, RC, and STI discussions increased significantly (p < 0.0001) when compared with historical clinical data for both TIPS-Basic and TIPS-Plus. Conclusions: We did not find an added benefit of patient activation messages in increasing frequency of sensitive discussions. Several patient characteristics appear to influence providers' likelihood of conversations about harmful partner behaviors. Compared with prior data, this pilot study suggests potential benefits of using provider scripts to guide discussions.
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Affiliation(s)
- Amber L Hill
- 1 Division of Adolescent and Young Adult Medicine, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Hadas Zachor
- 2 Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois
| | - Kelley A Jones
- 1 Division of Adolescent and Young Adult Medicine, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Janine Talis
- 1 Division of Adolescent and Young Adult Medicine, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Sarah Zelazny
- 3 Allegheny Health Network Trauma Centers, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Elizabeth Miller
- 1 Division of Adolescent and Young Adult Medicine, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Culyba AJ, Abebe KZ, Albert SM, Jones KA, Paglisotti T, Zimmerman MA, Miller E. Association of Future Orientation With Violence Perpetration Among Male Youths in Low-Resource Neighborhoods. JAMA Pediatr 2018; 172:877-879. [PMID: 29971322 PMCID: PMC6143064 DOI: 10.1001/jamapediatrics.2018.1158] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This study investigates the association between future orientation and violence perpetration among male youths in low-resource neighborhoods.
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Affiliation(s)
- Alison J. Culyba
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Kaleab Z. Abebe
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Steven M. Albert
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kelley A. Jones
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Taylor Paglisotti
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Zachor H, Chang JC, Zelazny S, Jones KA, Miller E. Training reproductive health providers to talk about intimate partner violence and reproductive coercion: an exploratory study. Health Educ Res 2018; 33:175-185. [PMID: 29506072 PMCID: PMC6018988 DOI: 10.1093/her/cyy007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 02/05/2018] [Indexed: 06/08/2023]
Abstract
To explore the effect of provider communication-skills training on frequency of intimate partner violence (IPV) and reproductive coercion (RC) assessment, four family planning clinics were randomized to IPV/RC communication-skills building workshop or standard knowledge-based IPV/RC training and compared to historical controls from the same clinics (before any training). Female patients aged 16-29 completed after-visit surveys. Primary outcomes included provider discussion about IPV/RC, receipt of safety card with IPV/RC resources and patient disclosure of IPV/RC. Chi-square tests were used to compare groups that received training and historical controls. Participants (training: n = 103; historical control: n = 576) were predominantly white with mean age of 22. More patients reported discussion about healthy relationships in both training groups (78-90%) compared to historical controls (49-52%, P < 0.001 for both). Discussion on birth control sabotage and pregnancy coercion was infrequent with patient-participants in both groups (6-17 and 4-13%, respectively). More patients in the clinics that received training reported receiving a safety card (72-84%) as compared to historical controls (9%, P < 0.001 for both). Overall, in this exploratory study, both communication-skills and standard training improved frequency of IPV communication when compared to historical controls but with few differences when compared to each other.
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Affiliation(s)
- H Zachor
- University of Pittsburgh School of Medicine, 3550 Terrace St, Pittsburgh, PA 15213, USA
| | - J C Chang
- Department of Obstetrics, Gynecology, and Reproductive Sciences and the Magee-Women’s Research Institute, Department of Medicine, University of Pittsburgh, 3380 Boulevard of the Allies, suite 309, Pittsburgh, PA 15213, USA
| | - S Zelazny
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, 3420 Fifth Ave., Pittsburgh, PA 15213, USA
| | - K A Jones
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, 3420 Fifth Ave., Pittsburgh, PA 15213, USA
| | - E Miller
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, 3420 Fifth Ave., Pittsburgh, PA 15213, USA
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Abebe KZ, Jones KA, Rofey D, McCauley HL, Clark DB, Dick R, Gmelin T, Talis J, Anderson J, Chugani C, Algarroba G, Antonio A, Bee C, Edwards C, Lethihet N, Macak J, Paley J, Torres I, Van Dusen C, Miller E. A cluster-randomized trial of a college health center-based alcohol and sexual violence intervention (GIFTSS): Design, rationale, and baseline sample. Contemp Clin Trials 2018; 65:130-143. [PMID: 29287667 PMCID: PMC5803349 DOI: 10.1016/j.cct.2017.12.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 12/09/2017] [Accepted: 12/20/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Sexual violence (SV) on college campuses is common, especially alcohol-related SV. This is a 2-arm cluster randomized controlled trial to test a brief intervention to reduce risk for alcohol-related sexual violence (SV) among students receiving care from college health centers (CHCs). Intervention CHC staff are trained to deliver universal SV education to all students seeking care, to facilitate patient and provider comfort in discussing SV and related abusive experiences (including the role of alcohol). Control sites provide participants with information about drinking responsibly. METHODS Across 28 participating campuses (12 randomized to intervention and 16 to control), 2292 students seeking care at CHCs complete surveys prior to their appointment (baseline), immediately after (exit), 4months later (T2) and one year later (T3). The primary outcome is change in recognition of SV and sexual risk. Among those reporting SV exposure at baseline, changes in SV victimization, disclosure, and use of SV services are additional outcomes. Intervention effects will be assessed using generalized linear mixed models that account for clustering of repeated observations both within CHCs and within students. RESULTS Slightly more than half of the participating colleges have undergraduate enrollment of ≥3000 students; two-thirds are public and almost half are urban. Among participants there were relatively more Asian (10 v 1%) and Black/African American (13 v 7%) and fewer White (58 v 74%) participants in the intervention compared to control. CONCLUSIONS This study will offer the first formal assessment for SV prevention in the CHC setting. Clinical Trials #: NCT02355470.
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Affiliation(s)
- Kaleab Z Abebe
- Division of General Internal Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States.
| | - Kelley A Jones
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States
| | - Dana Rofey
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States; Department of Psychiatry, University of Pittsburgh and Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Heather L McCauley
- Human Development & Family Studies, Michigan State University, East Lansing, MI, United States
| | - Duncan B Clark
- Department of Psychiatry, University of Pittsburgh and Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Rebecca Dick
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States
| | - Theresa Gmelin
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States
| | - Janine Talis
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States
| | - Jocelyn Anderson
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States
| | - Carla Chugani
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States
| | - Gabriela Algarroba
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States
| | - Ashley Antonio
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States
| | - Courtney Bee
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States
| | - Clare Edwards
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States
| | - Nadia Lethihet
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States
| | - Justin Macak
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States
| | - Joshua Paley
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States
| | - Irving Torres
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States
| | - Courtney Van Dusen
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States
| | - Elizabeth Miller
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States
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Kazmerski TM, Sawicki GS, Miller E, Jones KA, Abebe KZ, Tuchman LK, Ladores S, Rubenstein RC, Sagel SD, Weiner DJ, Pilewski JM, Orenstein DM, Borrero S. Sexual and reproductive health care utilization and preferences reported by young women with cystic fibrosis. J Cyst Fibros 2018; 17:64-70. [DOI: 10.1016/j.jcf.2017.08.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 08/12/2017] [Accepted: 08/13/2017] [Indexed: 01/06/2023]
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Abebe KZ, Jones KA, Ciaravino S, Ripper L, Paglisotti T, Morrow SE, Grafals M, Van Dusen C, Miller E. A cluster-randomized trial of a middle school gender violence prevention program: Design, rationale, and sample characteristics. Contemp Clin Trials 2017; 62:11-20. [PMID: 28821469 DOI: 10.1016/j.cct.2017.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 02/23/2017] [Revised: 08/13/2017] [Accepted: 08/14/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION High rates of adolescent relationship abuse (ARA) and sexual violence (SV) reported among adolescents point to the need for prevention among middle school-age youth. This is a cluster randomized controlled trial to test an athletic coach-delivered ARA/SV prevention program in 41 middle schools (38 clusters). Trained coaches talk to their male athletes about 1) what constitutes harmful vs. respectful relationship behaviors, 2) dispelling myths that glorify male sexual aggression and promoting more gender-equitable attitudes, and 3) positive bystander intervention when aggressive male behaviors toward females are witnessed. METHODS A total of 973 male athletes (ages 11-14, grades 6-8) are participating. Athletes complete surveys at the beginning and end of sports season (Time 2), and one year later (Time 3). The primary outcome is an increase in positive bystander behaviors (i.e., intervening in peers' disrespectful or harmful behaviors); secondary outcomes are changes in recognition of what constitutes abusive behavior, intentions to intervene, and gender equitable attitudes (Time 2 and 3) as well as reduction in abuse perpetration (Time 3). RESULTS Participating schools have a greater proportion of non-White students and students on free/reduced lunch compared to schools that declined participation. Participants' self-reported ethnicities are 54.5% White, 29.0% Black, 1.4% Hispanic and the remainder, multi-racial, other, or not reported. CONCLUSIONS This study will evaluate the effectiveness of a coach-delivered ARA/SV prevention program for middle school male athletes. Findings will add to the evidence base regarding developmentally appropriate violence prevention programs as well as the role of coaches in adolescent health promotion. Clinical Trials #: NCT02331238.
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Affiliation(s)
- Kaleab Z Abebe
- Division of General Internal Medicine, University of Pittsburgh, School of Medicine, 200 Meyran Ave., Suite 300, Pittsburgh, PA 15213, USA.
| | - Kelley A Jones
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh, School of Medicine, 3420 Fifth Ave, Pittsburgh, PA 15213, USA
| | - Samantha Ciaravino
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh, School of Medicine, 3420 Fifth Ave, Pittsburgh, PA 15213, USA
| | - Lisa Ripper
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh, School of Medicine, 3420 Fifth Ave, Pittsburgh, PA 15213, USA
| | - Taylor Paglisotti
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh, School of Medicine, 3420 Fifth Ave, Pittsburgh, PA 15213, USA
| | - Sarah Elizabeth Morrow
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh, School of Medicine, 3420 Fifth Ave, Pittsburgh, PA 15213, USA
| | - Melanie Grafals
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh, School of Medicine, 3420 Fifth Ave, Pittsburgh, PA 15213, USA
| | - Courtney Van Dusen
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh, School of Medicine, 3420 Fifth Ave, Pittsburgh, PA 15213, USA
| | - Elizabeth Miller
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh, School of Medicine, 3420 Fifth Ave, Pittsburgh, PA 15213, USA
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Miller E, McCauley HL, Decker MR, Levenson R, Zelazny S, Jones KA, Anderson H, Silverman JG. Implementation of a Family Planning Clinic-Based Partner Violence and Reproductive Coercion Intervention: Provider and Patient Perspectives. Perspect Sex Reprod Health 2017; 49:85-93. [PMID: 28272840 PMCID: PMC5453817 DOI: 10.1363/psrh.12021] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 12/19/2016] [Accepted: 01/11/2017] [Indexed: 05/27/2023]
Abstract
CONTEXT Despite multiple calls for clinic-based services to identify and support women victimized by partner violence, screening remains uncommon in family planning clinics. Furthermore, traditional screening, based on disclosure of violence, may miss women who fear reporting their experiences. Strategies that are sensitive to the signs, symptoms and impact of trauma require exploration. METHODS In 2011, as part of a cluster randomized controlled trial, staff at 11 Pennsylvania family planning clinics were trained to offer a trauma-informed intervention addressing intimate partner violence and reproductive coercion to all women seeking care, regardless of exposure to violence. The intervention sought to educate women about available resources and harm reduction strategies. In 2013, at the conclusion of the trial, 18 providers, five administrators and 49 patients completed semistructured interviews exploring acceptability of the intervention and barriers to implementation. Consensus and open coding strategies were used to analyze the data. RESULTS Providers reported that the intervention increased their confidence in discussing intimate partner violence and reproductive coercion. They noted that asking patients to share the educational information with other women facilitated the conversation. Barriers to implementation included lack of time and not having routine reminders to offer the intervention. Patients described how receiving the intervention gave them important information, made them feel supported and less isolated, and empowered them to help others. CONCLUSIONS A universal intervention may be acceptable to providers and patients. However, successful implementation in family planning settings may require attention to system-level factors that providers view as barriers.
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Affiliation(s)
- Elizabeth Miller
- director, Division of Adolescent and Young Adult Medicine, Children's Hospital of Pittsburgh, and professor of pediatrics, Department of Pediatrics, University of Pittsburgh School of Medicine
| | - Heather L McCauley
- assistant professor, Human Development & Family Studies, Michigan State University, East Lansing, and assistant professor, Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine
| | - Michele R Decker
- associate professor, Department of Population, Family and Reproductive Health, and director, Women's Health & Rights Program, Center for Public Health & Human Rights, Bloomberg School of Public Health, Johns Hopkins University, Baltimore
| | | | - Sarah Zelazny
- clinical research assistant, Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine
| | - Kelley A Jones
- postdoctoral associate, Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine
| | - Heather Anderson
- clinical research coordinator, Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine
| | - Jay G Silverman
- director of research, Center on Gender Equity and Health, and professor of medicine and global public health, University of California, San Diego, La Jolla
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Radford DR, Hellyer P, Meakin N, Jones KA. Identifying and preparing the next generation of part-time clinical teachers from dental practice. Br Dent J 2017; 219:319-22. [PMID: 26450243 DOI: 10.1038/sj.bdj.2015.748] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2015] [Indexed: 11/09/2022]
Abstract
Part-time general dental practitioners (GDPs) and dental care professionals (DCPs) working in practice are being increasingly utilised to deliver undergraduate clinical dental education to both dental and hygiene/therapy students. As such, there is a need for appropriate recruitment processes and ongoing staff development in the different and complex role of the clinical teacher. Recently a group of experienced dental practitioners, making a journey from GDP to part-time clinical teacher, identified common themes, experiences, challenges and realisations. These were: 'what is clinical dental education?'; 'me as a clinical teacher'; and 'specific teaching issues'. The themes highlighted the complexity of dental education and the different environment of the teaching clinic from general practice. Some of the themes identified could be a starting point for the induction process to facilitate an easier transition from experienced GDP to clinical teacher. With the current demands from both students and patients alike, the 'three way dynamic of patient, student and teacher' needs to be supported if dental schools are to attract and develop the highest quality clinical teachers. It is of critical importance to give an exceptional experience to students in their clinical education as well as to patients in terms of excellent and appropriate treatment. The challenge for deans and directors of education is to find the resources to properly fund teacher recruitment, induction and the development of part-time GDPs in order to produce the expert teachers of tomorrow.
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Affiliation(s)
- D R Radford
- Integrated Dental Education and Multi-Professional Care, Kings College London Dental Institute
| | - P Hellyer
- Kings College London Dental Institute and University of Portsmouth Dental Academy, Faculty of Science, William Beatty Building, Portsmouth, PO1 2QG
| | - N Meakin
- Kings College London Dental Institute and University of Portsmouth Dental Academy, Faculty of Science, William Beatty Building, Portsmouth, PO1 2QG
| | - K A Jones
- Kings College London Dental Institute and University of Portsmouth Dental Academy, Faculty of Science, William Beatty Building, Portsmouth, PO1 2QG
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McCauley HL, Silverman JG, Jones KA, Tancredi DJ, Decker MR, McCormick MC, Austin SB, Anderson HA, Miller E. Psychometric properties and refinement of the Reproductive Coercion Scale. Contraception 2016; 95:292-298. [PMID: 27639927 DOI: 10.1016/j.contraception.2016.09.010] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 09/06/2016] [Accepted: 09/07/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Identification and refinement of psychometric properties of the Reproductive Coercion Scale (RCS) for use in survey research and clinical practice. STUDY DESIGN Young women aged 16-29 years seeking services in 24 Pennsylvania and 5 California family planning clinics completed questionnaires. Data were pooled for analysis (n=4674), and underlying domains were assessed using Horn's Parallel Analysis and Exploratory Factor Analysis. Multidimensional Item Response Theory was used to refine the scale and assess reliability and validity of a short-form RCS. RESULTS The full, nine-item RCS had two underlying domains: pregnancy coercion and condom manipulation. Five items were retained in the short form: three about pregnancy coercion (e.g., "told you not to use birth control…") and two for condom manipulation (e.g., "taken off the condom while you were having sex…"; one of these items is the combination of two original items on damaging the condom that were combined because of similar statistical properties and face validity and a third item on removing the condom was retained on its own). Recent reproductive coercion was reported by 6.7% and 6.3% of the sample with the full and short-form RCS, respectively. Characteristics of women reporting reproductive coercion were similar with both forms. CONCLUSION Findings indicate that reproductive coercion includes pregnancy coercion and deliberate manipulation of condoms to promote pregnancy. Moreover, women experience reproductive coercion across a continuum of severity. We selected items that varied in RC severity and discrimination to generate a five-item short-form RCS for survey research and clinical practice. IMPLICATIONS This study assesses the psychometric properties of the RCS, identifying pregnancy coercion and condom manipulation as underlying domains of reproductive coercion. Recommendations for using the RCS in research and clinical practice are discussed.
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Affiliation(s)
- Heather L McCauley
- Department of Human Development & Family Studies, Michigan State University, East Lansing, MI, USA.
| | - Jay G Silverman
- Division of Global Public Health, Department of Medicine & Center on Gender Equity & Health, University of California, San Diego, La Jolla, CA, USA
| | - Kelley A Jones
- Division of Adolescent & Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Daniel J Tancredi
- Department of Pediatrics and Center for Healthcare Policy & Research, University of California, Davis, Sacramento, CA, USA
| | - Michele R Decker
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Marie C McCormick
- Department of Social & Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - S Bryn Austin
- Department of Social & Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Heather A Anderson
- Division of Adolescent & Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Elizabeth Miller
- Division of Adolescent & Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Jones KA, Cornelius MD, Silverman JG, Tancredi DJ, Decker MR, Haggerty CL, De Genna NM, Miller E. Abusive Experiences and Young Women's Sexual Health Outcomes: Is Condom Negotiation Self-Efficacy a Mediator? Perspect Sex Reprod Health 2016; 48:57-64. [PMID: 27077497 PMCID: PMC4909564 DOI: 10.1363/48e8616] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Revised: 11/19/2015] [Accepted: 11/20/2015] [Indexed: 05/12/2023]
Abstract
CONTEXT Intimate partner violence and reproductive coercion are associated with unintended pregnancies and STDs. Greater condom negotiation self-efficacy among young women may mediate these associations. METHODS A sample of 841 female adolescents (aged 16-19) and 1,387 young adult women (aged 20-24) recruited from 24 family planning clinics in western Pennsylvania in 2011-2012 reported on intimate partner violence, reproductive coercion, condom negotiation self-efficacy and sexual health outcomes at baseline and four- and 12-month follow-ups. Mixed models were used to test associations of intimate partner violence and reproductive coercion with unintended pregnancy and STD diagnosis. The Sobel test of mediation was used to measure indirect effects of condom negotiation self-efficacy. RESULTS At baseline, 15% of adolescents and 11% of young adults reported recent intimate partner violence victimization; 7% and 6%, respectively, reported recent reproductive coercion. For both age-groups, intimate partner violence and reproductive coercion were associated with a reduced level of condom negotiation self-efficacy (coefficients, -0.27 to -0.13) and increased odds of STD diagnosis (odds ratios, 1.03-1.1). However, only reproductive coercion was associated with unintended pregnancy (odds ratios, 1.1 for each group). The only association that condom negotiation self-efficacy mediated was between reproductive coercion and unintended pregnancy among young adults (17% of total effect). CONCLUSIONS Targeting condom negotiation self-efficacy alone in abusive relationships would likely not translate into improved sexual health outcomes in this population. Other strategies are needed to prevent unintended pregnancy and STDs.
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Affiliation(s)
- Kelley A Jones
- Division of Adolescent and Young Adult Medicine, School of Medicine, University of Pittsburgh.
| | - Marie D Cornelius
- Department of Psychiatry, School of Medicine, University of Pittsburgh
| | - Jay G Silverman
- Division of Global Public Health, School of Medicine, University of California, San Diego, La Jolla, CA
| | - Daniel J Tancredi
- Department of Pediatrics, School of Medicine, University of California, Davis, Sacramento, CA
| | - Michele R Decker
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Catherine L Haggerty
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh
| | | | - Elizabeth Miller
- Department of Pediatrics, School of Medicine, University of Pittsburgh
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Miller E, Tancredi DJ, Decker MR, McCauley HL, Jones KA, Anderson H, James L, Silverman JG. A family planning clinic-based intervention to address reproductive coercion: a cluster randomized controlled trial. Contraception 2016; 94:58-67. [PMID: 26892333 DOI: 10.1016/j.contraception.2016.02.009] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [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: 12/19/2015] [Revised: 02/01/2016] [Accepted: 02/07/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We assessed the effectiveness of a provider-delivered intervention targeting reproductive coercion, an important factor in unintended pregnancy. STUDY DESIGN We randomized 25 family planning clinics (17 clusters) to deliver an education/counseling intervention or usual care. Reproductive coercion and partner violence victimization at 1 year follow-up were primary outcomes. Unintended pregnancy, recognition of sexual and reproductive coercion, self-efficacy to use and use of harm reduction behaviors to reduce victimization and contraception nonuse, and knowledge and use of partner violence resources were secondary outcomes. Analyses included all available data using an intention-to-treat approach. RESULTS Among 4009 females ages 16 to 29 years seeking care, 3687 completed a baseline survey prior to clinic visit from October 2011 to November 2012; 3017 provided data at 12-20weeks post-baseline (T2) and 2926 at 12months post-baseline (T3) (79% retention). Intervention effects were not significant for reproductive coercion [adjusted risk ratio (ARR) 1.50 (95% confidence interval 0.95-2.35)] or partner violence [ARR 1.07 (0.84-1.38)]. Intervention participants reported improved knowledge of partner violence resources [ARR 4.25 (3.29-5.50)] and self-efficacy to enact harm reduction behaviors [adjusted mean difference 0.06 (0.02-0.10)]. In time point-specific models which included moderating effects of exposure to reproductive coercion at baseline, a higher reproductive coercion score at baseline was associated with a decrease in reproductive coercion 1 year later (T3). Use and sharing of the domestic violence hotline number also increased. CONCLUSION This brief clinic intervention did not reduce partner violence victimization. The intervention enhanced two outcomes that may increase safety for women, specifically awareness of partner violence resources and self-efficacy to enact harm reduction behaviors. It also appeared to reduce reproductive coercion among women experiencing multiple forms of such abuse.
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Affiliation(s)
- Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Daniel J Tancredi
- Department of Pediatrics and Center for Healthcare Policy and Research, University of California, Davis, Sacramento, CA, USA
| | - Michele R Decker
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Heather L McCauley
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Kelley A Jones
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Heather Anderson
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Lisa James
- Futures Without Violence, San Francisco, CA, USA
| | - Jay G Silverman
- Division of Global Public Health in the Department of Medicine & Center on Gender Equity and Health, University of California, San Diego, La Jolla, CA, USA
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Jones KA, Choong AMTL, Canham N, Renton S, Pollitt R, Nesbitt M, Kopcke D, Islam L, Buckley J, Ghali N, Vandersteen A. A combined vascular surgical and clinical genetics approach to diffuse aneurysmal disease. Ann R Coll Surg Engl 2015; 97:e73-6. [PMID: 26264107 DOI: 10.1308/003588415x14181254790121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 11/22/2022] Open
Abstract
We report two patients who presented with extensive aneurysmal disease, in association with minimal external physical signs. Patient 1 remained genetically undiagnosed despite multiple structural, biochemical and genetic investigations. He made a good recovery following surgery for popliteal and left axillary artery aneurysms. Patient 2 was diagnosed with vascular type Ehlers-Danlos syndrome, associated with a high degree of tissue and blood vessel fragility, and is being managed conservatively. Early multidisciplinary assessment of such patients facilitates accurate diagnosis and management.
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Affiliation(s)
- K A Jones
- Outer London North West Vascular Unit, Northwick Park Hospital, London North West Healthcare NHS Trust , UK
| | | | - N Canham
- North West London Regional Genetics Service, Level 8V, Saint Mark's Hospital, London North West Healthcare NHS Trust , UK
| | - S Renton
- Outer London North West Vascular Unit, Northwick Park Hospital, London North West Healthcare NHS Trust , UK
| | - R Pollitt
- Ehlers-Danlos Syndrome National Diagnostic Service, Sheffield Children's Hospitals NHS Foundation Trust , UK
| | - M Nesbitt
- Ehlers-Danlos Syndrome National Diagnostic Service, Sheffield Children's Hospitals NHS Foundation Trust , UK
| | - D Kopcke
- Department of Radiology, Northwick Park Hospital, London North West Healthcare NHS Trust , UK
| | - L Islam
- West Midlands Regional Genetics Service, Birmingham Women's NHS Foundation Trust , UK
| | - J Buckley
- Department of Infectious diseases, Northwick Park Hospital, London North West Healthcare NHS Trust , UK
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