Health Care Seeking and Risk Behaviors among High School Students in the Context of a School-Based Health Center

Background. To address adolescent health needs in urban Wyandotte County, Kansas, a school-based health center (SBHC) was opened in March 2012. Students were surveyed to inform SBHC operations. Methods. All Wyandotte High School students were invited to complete an online survey in class in May 2012. Questions on demographics, health care seeking behaviors, behavioral risk factors, and missed school days were included. Results. Of 1,240 eligible students, 398 responded (32.3%). Nearly half (45.8%) reported that the emergency room or hospital was the location where they usually would seek health care. Females were more likely than males to report less access to mental health counseling (15.1% vs 10.8%, p = 0.01) or reproductive health care (7.7% vs 5.7%, p = 0.03) when needed and were more likely to miss school due to a health problem (54.0% vs 37.9% missed ≥ 1 day in past 4 weeks, p = 0.006). Males were more likely to report having had sex (59.2% vs 46.9%, p = 0.02) while females were more likely to report never using a condom when having sex (30.6% vs 18.3%, p = 0.001). Almost two-thirds (61.9%) of respondents were aware of the SBHC; 18.7% had used the SBHC. Conclusions. Students do not have adequate access to primary care, including sexual and mental health care. Using these data, the SBHC can be better adapted to meet student needs

Human Papillomavirus Vaccine Frequency for University of Kansas Medical Center Pediatric Patients

Background. Human papillomavirus (HPV) vaccination is recommendedfor all adolescents aged 11 to 12 years, but coveragein Kansas is exceptionally poor. To understand local coverage, receiptof the 3-dose HPV vaccine series among pediatric patients atthe University of Kansas Medical Center (KUMC) was evaluated. Methods. All patients aged 11 to 12 years who were seen by aKUMC primary care provider (family medicine and pediatrics)in 2013 were included in the retrospective chart review. Recordswere reviewed through December 31, 2014 to capture the numberof HPV doses received, and receipt of other recommendedvaccines (tetanus-diphtheria-pertussis and meningococcal conjugate).Pearson’s chi-squared tests were used to evaluate relationshipsbetween HPV vaccination and patient characteristics. Results. Of the 261 eligible females and 243 eligible males, 71.2%received ≥ 1 HPV vaccine dose, 55.2% received ≥ 2 doses, and39.3% completed the HPV vaccine series (3 doses). Although vaccineinitiation was slightly lower in males compared to females(67.1% vs. 75.1%, p = 0.047), no difference in vaccine completionwas seen between males and females (37.0% vs. 41.7%, p = 0.319).Over 80% of patients received other concurrently recommendedvaccines (Tdap: 81.7%, meningococcal: 81.3%). HPV series completionoccurred more often among Spanish-speaking femalescompared to English-speaking females (59.5% vs 37.7%; p < 0.01).Conclusions. The proportion of adolescents who received theHPV vaccination at KUMC is substantially higher than nationaland state estimates, but there is room for improvement forboth initiation and series completion. KS J Med 2016;9(1):1-5

Detection of Pelvic Inflammatory Disease: Development of an Automated Case-Finding Algorithm Using Administrative Data

ICD-9 codes are conventionally used to identify pelvic inflammatory disease (PID) from administrative data for surveillance purposes. This approach may include non-PID cases. To refine PID case identification among women with ICD-9 codes suggestive of PID, a case-finding algorithm was developed using additional variables. Potential PID cases were identified among women aged 15–44 years at Group Health (GH) and Kaiser Permanente Colorado (KPCO) and verified by medical record review. A classification and regression tree analysis was used to develop the algorithm at GH; validation occurred at KPCO. The positive predictive value (PPV) for using ICD-9 codes alone to identify clinical PID cases was 79%. The algorithm identified PID appropriate treatment and age 15–25 years as predictors. Algorithm sensitivity (GH = 96.4%; KPCO = 90.3%) and PPV (GH = 86.9%; KPCO = 84.5%) were high, but specificity was poor (GH = 45.9%; KPCO = 37.0%). In GH, the algorithm offered a practical alternative to medical record review to further improve PID case identification