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Reproductive Coercion and Relationship Abuse Among Adolescents and Young Women Seeking Care at School Health Centers.

ObjectiveTo investigate demographic differences and evaluate how reproductive coercion and relationship abuse influences young females' care-seeking and sexual health behaviors.MethodsWe conducted a secondary analysis of cross-sectional baseline survey data from sexually active female students (aged 14-19 years) who sought care from school health centers. Outcomes included recent (previous 3 months) reproductive coercion, physical or sexual adolescent relationship abuse, and nonpartner sexual violence victimization. Cluster-adjusted χ tests compared demographics and generalized linear mixed models estimated associations among reproductive coercion, adolescent relationship abuse (physical and sexual abuse in romantic relationships), and care-seeking and sexual health behaviors.ResultsOf 550 sexually active high school females, 12% reported recent reproductive coercion and 17% reported physical or sexual adolescent relationship abuse, with no significant demographic differences. Prevalence of recent nonpartner sexual violence was 17%. There were no observed significant differences in care-seeking behaviors among those with recent reproductive coercion compared with those without. Physical or sexual adolescent relationship abuse was associated with increased odds of seeking testing or treatment for sexually transmitted infections (adjusted odds ratio [aOR] 2.08, 95% CI 1.05-4.13). Females exposed to both adolescent relationship abuse and reproductive coercion had higher odds of having a partner who was 5 or more years older (aOR 4.66, 95% CI 1.51-14.4), having two or more recent sexual partners (aOR 3.86, 95% CI 1.57-9.48), and using hormonal contraception only (aOR 3.77, 95% CI 1.09-13.1 vs hormonal methods with condoms).ConclusionAlmost one in eight females experienced recent reproductive coercion. We did not observe significant demographic differences in reproductive coercion. Partner age and number of sexual partners may elevate risk for abusive relationships. Relationship abuse is prevalent among high school students seeking care, with no clear pattern for case identification. By failing to identify factors associated with harmful partner behaviors, our results support universal assessment for reproductive coercion and relationship abuse among high school-aged adolescents, involving education, resources, and harm-reduction counseling to all patients.Clinical trial registrationClinicalTrials.gov, NCT01678378

Feasibility of the Positive Thoughts and Actions Prevention Program for Middle Schoolers at Risk for Depression

Despite the importance of adolescent depression, few school-based prevention programs have been developed and tested in the United States with middle school populations. This study examined the acceptability and changes in targeted outcomes for a new preventative program, Positive Thoughts and Actions (PTA). Sixty-seven 7th grade students with elevated depressive symptoms were recruited from public schools and randomized to the 12-week PTA program with a parent-component or to a school-as-usual control group. The PTA prevention program was well received by students and parents, yielding high rates of participation and satisfaction among those randomized to receive the intervention. However, analyses of the efficacy of the program in changing depressive symptoms were not significant. In terms of our proximal program targets, most differences were not statistically significant, though effect sizes suggested advantage of PTA over control group in coping, cognitive style, and parent-child communication. This preliminary research highlights a need for further testing of programs for school-based prevention of depression and promotion of positive emotional health

A Study of the Feasibility of a Transfer of Development Rights Program in Lewiston, Maine

This project was conducted in collaboration with David Hedinger in Lewiston’s City Planning Office in order to assess the feasibility of a Transfer of Development Rights (TDR) Program in Lewiston. The overall aim of this project was to apply scholarly literature, findings from case studies, and input from experienced professionals to determine what successful TDR programs look like, the factors they possess, and the conditions present. The primary problem that TDR programs seek to address is urban sprawl, or the slow spread of development outside of the urban centers into the rural fringes. Urban sprawl has two chief components: 1) it leads to the loss of valuable environmental assets, open space, and potential agricultural land to development; and 2) it pulls money and investment outside of urban centers and leaves them economically depressed and sometimes even blighted (Bruegmann 2005, 160). In terms of Lewiston, while on a smaller scale than many other cities across the country, the problems of urban sprawl are still being felt. A TDR program, which allows a landowner to voluntarily relinquish their right to develop on their rural land and sell that right to a developer looking to increase density in the urban or suburban growth zones, has been a proven to be a reasonable and cost effective way to mitigate the problems of sprawl. A successful TDR program, however, requires certain conditions and factors to be present. Many TDR programs across the country and even in Maine have failed because they were either improperly designed or under-stimulated by market conditions. The leading cause of failure in a TDR program is a lack of demand for high density development (Pruetz & Standridge 2009, 80). Without this necessary demand there is no driving force that will spur a TDR program into motion. Additionally, we found that the most effective TDR programs at preserving land are those administered at the county, regional, or state level (King County 2014; Montgomery County 2008; Pinelands 2009). Our primary findings show that there are many factors that lead to successful TDR programs. And while Lewiston may possess the physical makeup of a successful TDR program: designated urban growth zones and large tracts of rural and agricultural land, it still lacks many factors that may be difficult to stimulate in the short term. We conclude with these remarks and offer a few alternatives to traditional TDR programs that could also be used to preserve land and promote smart growth

Evaluating the Impact of Variable Planting Dates and the Use of Plant Growth Regulators on Fall Stand Establishment, Winter Hardiness, and Yield of Winter Canola in Oklahoma

This thesis contains two research papers about winter canola.Plant & Soil Science

Effects of Oklahoma Cross Timbers Riparian Vegetation Composition on Avian Community Dynamics

This study is a descriptive analysis of the avian communities in riparian vegetation throughout an entire year. It was designed to suggest possible alternatives for consideration in the management of the quality of riparian habitat. The project included an investigation of optimum width range of vegetation belts and how the vegetation structure relates to the bird community. The importance of the size and structure of the riparian habitat to woodland dependent bird species of the Cross Timbers region of Oklahoma was emphasized.Wildlife Ecolog

A Technical Assistance Model to Facilitate Use of the School Health Index to Assess Chronic Health Condition Management in Schools

Introduction: Chronic health conditions, such as asthma and food allergies, affect a substantial proportion of school-aged children in New Mexico (NM). School health services, policies, programs, and practices can affect daily management of chronic pediatric health conditions. The Center for Disease Control and Prevention’s School Health Index (SHI) is a self-assessment and planning guide that evaluates school services, policies, and programs for promoting health and safety. Our aim was to determine if a technical assistance (TA) model could effectively support school districts in using the SHI to complete a chronic disease needs assessment (CDNA). Methods: Seven public and one charter school participated in the pilot. We used a TA model to guide service and systems change. We evaluated the context in which the school teams were functioning, built a partnership with key contacts, and worked through the three phases of the model. Results: SHI questions were limited to only those related to chronic disease management. To complete the planning for improvement section, we held a group training in which school teams participated in an action-planning exercise to choose next steps. Seven of eight schools completed the questions during the four-week pilot period. School teams said that they needed more time to accurately complete the assessments and had difficulty choosing next steps during the action planning activity because of lack of stakeholder presence. Conclusions: The SHI is a complex and lengthy assessment for schools to undertake. We effectively used a TA model to provide structured assistance for implementing a multi-district CDNA. Sufficient time and stakeholder involvement are required for accurate assessments and action planning

Implementing a Coordinated Care Model for Sex Trafficked Minors in Smaller Cities

Background Addressing the social and clinical service needs of minors who have been sexually exploited remains a challenge across the United States. While larger metropolitan centers have established shelters and service provision specific for trafficked persons, in smaller cities and more rural settings, survivors of trafficking (especially minors) are usually served by multiple, disparate social service and health providers working across different systems. Sexually exploited minors present an even greater challenge due to intersections with child welfare and juvenile justice systems, histories of abuse by family that limit placement options, and limited services that address the complex medical, mental health, and psychosocial needs of these youth. Major health organizations have recommended a coordinated care model that integrates the therapeutic and social service needs of trafficked persons including housing and education; implementation of such service provision requires intensive, multi-sectoral collaboration. Methods We present two case studies from an anti-trafficking coalition established in a smaller urban area. Findings/Conclusions Multi-sector collaboration requires the development of policies and protocols for addressing the diverse needs (acute and ongoing) of trafficked minors who are often “dual jurisdiction,” involved in both the juvenile justice and child welfare systems. Principles of care including autonomy, empowerment, protection, and safety may be at odds as systems may approach these youth differently. A clearly identified care coordinator can help navigate across these systems and facilitate communication among service providers while protecting client privacy, confidentiality, and autonomy. Assessing the quality of services provided and accountability among service providers remain significant challenges, especially in resource limited settings

Impact of methodological "shortcuts" in conducting public health surveys: Results from a vaccination coverage survey

Abstract Background Lack of methodological rigor can cause survey error, leading to biased results and suboptimal public health response. This study focused on the potential impact of 3 methodological "shortcuts" pertaining to field surveys: relying on a single source for critical data, failing to repeatedly visit households to improve response rates, and excluding remote areas. Methods In a vaccination coverage survey of young children conducted in the Commonwealth of the Northern Mariana Islands in July 2005, 3 sources of vaccination information were used, multiple follow-up visits were made, and all inhabited areas were included in the sampling frame. Results are calculated with and without these strategies. Results Most children had at least 2 sources of data; vaccination coverage estimated from any single source was substantially lower than from all sources combined. Eligibility was ascertained for 79% of households after the initial visit and for 94% of households after follow-up visits; vaccination coverage rates were similar with and without follow-up. Coverage among children on remote islands differed substantially from that of their counterparts on the main island indicating a programmatic need for locality-specific information; excluding remote islands from the survey would have had little effect on overall estimates due to small populations and divergent results. Conclusion Strategies to reduce sources of survey error should be maximized in public health surveys. The impact of the 3 strategies illustrated here will vary depending on the primary outcomes of interest and local situations. Survey limitations such as potential for error should be well-documented, and the likely direction and magnitude of bias should be considered.</p

Criterion validity of the Short Mood and Feelings Questionnaire and one- and two-item depression screens in young adolescents

<p>Abstract</p> <p>Background</p> <p>The use of short screening questionnaires may be a promising option for identifying children at risk for depression in a community setting. The objective of this study was to assess the validity of the Short Mood and Feelings Questionnaire (SMFQ) and one- and two-item screening instruments for depressive disorders in a school-based sample of young adolescents.</p> <p>Methods</p> <p>Participants were 521 sixth-grade students attending public middle schools. Child and parent versions of the SMFQ were administered to evaluate the child's depressive symptoms. The presence of any depressive disorder during the previous month was assessed using the Diagnostic Interview Schedule for Children (DISC) as the criterion standard. First, we assessed the diagnostic accuracy of child, parent, and combined scores of the full 13-item SMFQ by calculating the area under the receiver operating characteristic curve (AUC), sensitivity and specificity. The same approach was then used to evaluate the accuracy of a two-item scale consisting of only depressed mood and anhedonia items, and a single depressed mood item.</p> <p>Results</p> <p>The combined child + parent SMFQ score showed the highest accuracy (AUC = 0.86). Diagnostic accuracy was lower for child (AUC = 0.73) and parent (AUC = 0.74) SMFQ versions. Corresponding versions of one- and two-item screens had lower AUC estimates, but the combined versions of the brief screens each still showed moderate accuracy. Furthermore, child and combined versions of the two-item screen demonstrated higher sensitivity (although lower specificity) than either the one-item screen or the full SMFQ.</p> <p>Conclusions</p> <p>Under conditions where parents accompany children to screening settings (e.g. primary care), use of a child + parent version of the SMFQ is recommended. However, when parents are not available, and the cost of a false positive result is minimal, then a one- or two-item screen may be useful for initial identification of at-risk youth.</p