A 12-year follow up of principles learned in a pediatric dentistry Master of Public Health dual degree program applied to professional practice.

Introduction: Dental public health professionals play a critical role in preventing and controlling oral diseases. The purpose of this study was to assess the application of public health principles learned in a pediatric dentistry Master of Public Health (MPH) dual degree program to professional practice upon graduation. Methods: Semi-structured interviews were conducted with pediatric dentistry/MPH dual degree alumni who graduated from the program between 2012 and 2023. Interview questions inquired about characteristics of patient population, location of providers' clinic/organization, whether the program was worthwhile to their practice and application of principles learned in the program to their professional practice. Results: Twenty of the 22 program alumni agreed to be interviewed. All alumni thought the program was extremely worthwhile to their practice. They felt the MPH component of the program gave them the public health background and tools they needed to provide comprehensive and holistic care to their patients. Additionally, all alumni reported applying the public health principles they learned in the program to their professional practice through leadership roles, research and teaching that focuses on oral disease prevention and the promotion of dental health. Discussion: Given the importance of a dental public health professionals' role in reducing oral health disparities at the population level, more pediatric dentistry MPH dual degree programs are urgently needed. Additionally, more research is necessary to demonstrate the effectiveness of these programs, which will be critical to helping ensure the value of a dual degree in dentistry and public health is recognized and promoted worldwide.

Pediatric Oral Health Online Education for Rural and Migrant Head Start Programs in the United States.

Children living in rural and migrant areas in the United States disproportionately suffer from poor oral health. Additionally, there continues to be a shortage of pediatric dentists practicing in rural/migrant areas. The purpose of this formative research study was to assess whether staff, teachers and families from rural/migrant Head Start/Early Head Start (HS/EHS) programs in California were receptive to oral health online education workshops conducted by pediatric dental residents who were assisted by bilingual (English and Spanish) community oral health workers (COHWs). Our findings suggest that partnering pediatric dental residents with bilingual COHWs to educate HS/EHS teachers, staff and parents on oral health care in rural/migrant areas could result in a rewarding experience for pediatric dentists that might lead them to practice in these communities upon graduation from their residency program. Furthermore, the positive feedback received from the teachers, staff and parents who participated in the workshops indicates they were receptive to receiving oral health information related to oral health literacy from the dental providers and COHWs. COHWs can help increase access to oral health care by serving as a bridge between families and providers by relaying information in a cultural, linguistic and sensitive manner.

Mixed methods evaluation of an oral health education program for pediatric dental, medical and nursing providers.

PURPOSE: To evaluate the application of knowledge, attitudes, and skills learned in an oral health education program among pediatric dental and medical residents, and pediatric and family nurse practitioners (PNPs and FNPs). METHODS: A mixed methods study design included a year-end online survey and focus groups. Eighty participants completed the survey (94%) and seven focus groups were conducted (n = 69) representing each of the four cohorts in 2020-2022. Analysis of variance was used to assess differences in survey responses by dental/medical specialty. Focus group audio recordings were analyzed using Atlas.ti.22 to identify common themes. RESULTS: The program increased knowledge and skills in oral health core competencies and positive attitudes regarding oral health education. All PNPs (100%) and most pediatric medical residents (94%) and FNPs (91%) strongly agreed/agreed that the oral health program led to an increase in screening for early childhood caries, more confidence in applying fluoride varnish and providing oral health anticipatory guidance during patient visits. Most pediatric medical residents, PNPs and FNPS (98%) strongly agreed/agreed that primary care providers should incorporate oral health into their practice and provide referrals to dental professionals as part of well-child visits. CONCLUSIONS: The program improved oral health-related knowledge, attitudes and skills among dental and medical primary care providers. Future oral health education programs for health care professionals can use this model to help bridge the gap between dental and primary care and ultimately improve access to preventive oral health care for children and families.

Five-year follow-up of an interdisciplinary oral health education program: Clinical practice behaviors in working pediatric nurse practitioners.

ABSTRACT: Many interdisciplinary oral health education programs have been implemented for pediatric primary care providers (e.g., pediatric nurse practitioner [PNP]) to raise awareness and gain skills related to the prevention of early childhood caries (ECC). However, no studies have evaluated if these educational programs provided to PNPs during their training resulted in clinical practice behavior changes. A 33-item survey was designed on a web-based platform (Survey Monkey) and distributed to 71 PNP graduates. The survey included demographics, current clinical practice, clinical practice behaviors, and perceived barriers to practice. Descriptive statistics were used to assess the survey items and thematic analyses on the open-ended questions. The survey response rate was 70% (50/71 PNPs). Most practicing PNPs were in acute care or specialty clinics (n = 33; 66%) where oral health was not part of the focused visit. Majority used knowledge learned in assessment and anticipatory guidance skills. However, only 14% of primary care providers were applying fluoride varnish with 10% billing for this procedure. Barriers to application were time, available supplies, COVID protocols, lack of support staff, or not billing due to minimal reimbursement. Many primary care-trained PNPs were practicing in acute or subspecialty areas where prevention of ECC is not viewed as part of their focused visit. Pediatric nurse practitioners working in primary care demonstrated some clinical practice changes. However, areas for improvement are time to perform a risk assessment and application of fluoride varnish, access to these supplies, and standard billing and insurance reimbursement for these preventable services.

Addressing social determinants of oral health, structural racism and discrimination and intersectionality among immigrant and non-English speaking Hispanics in the United States.

BACKGROUND: The Hispanic population is the largest (18.5%) and fastest growing non-majority ethnic group in the United States (US), about half of whom are non-US born, and bears one of the highest oral disease burdens. Most current knowledge around oral health disparities in Hispanic populations examine the individual factors of culture, acculturation, and socioeconomic status. However, the root causes of this inequity; oral health literacy (OHL), social determinants of health (SDOH), structural racism and discrimination (SRD) and the intersectionality among the three, have not been well-studied. Addressing this critical gap will be central to advancing health equity and reducing oral health-related disparities in the Hispanic population, especially among immigrant and non-English speaking Hispanics. RESULTS: Recommendations for future OHL/SDOH/SRD-related research in oral health targeting Hispanic populations should include: (1) examining the direct and indirect effects of OHL/SDOH/SRD-related factors and intersectionality, (2) assessing the impact of SRD on oral health using zip-code level measures, (3) examining the role of OHL and SDOH as potential effect modifiers on the relationship between SRD and oral health outcomes, (4) conducting secondary data analysis to identify demographic, social and structural-level variables and correlations between and among variables to predict oral health outcomes, and (5) obtaining a deeper understanding of how OHL/SDOH and SRD factors are experienced among Hispanic immigrant and migrant populations. CONCLUSION: It is hoped these recommendations will lead to a better understanding of the mechanisms through which OHL, SDOH and SRD impact oral health outcomes among the largest minority population in the US so they can be addressed.

Improved oral health knowledge in a primary care pediatric nurse practitioner program.

ABSTRACT: Pediatric nurse practitioners (PNPs) are a significant workforce in primary care and are uniquely positioned to improve oral health in children through ongoing surveillance in the well-child visit. The purpose of this study was to evaluate PNP student satisfaction and knowledge gained with the integration of the Strategic Partnership for Interprofessional Collaborative Education in Pediatric Dentistry (SPICE-PD) oral health education program into the first-year primary care curriculum. A descriptive, comparative design examined dental test scores across the pre-SPICE-PD (2013-2014; n = 26) and post-SPICE-PD (2015-2020; n = 55) cohorts. An electronic survey was completed (n = 47; 67%), and focus group (n = 12) audio-recordings were analyzed using Atlas.ti 8.0. Chi-square test and independent samples t-test were used to assess differences between groups. The SPICE-PD students reported improved knowledge and skill in clinical practice. Focus group themes were oral health education was beneficial, impact of coronavirus disease 2019, and suggestions for improvement. Mean dental test scores improved pre- and post-SPICE-PD (83 vs. 93; p < .001). The SPICE-PD oral health education improved knowledge and was highly satisfying for students. Pediatric nurse practitioners are ideally positioned to integrate oral health into primary care services, thereby improving access to care and ultimately reducing or mitigating early childhood caries. Evaluation of PNP postgraduation practices in the primary care setting is needed to assess whether improved knowledge results in practice change.

Factors associated with HIV testing among youth in Tanzania based on the 2016-2017 Tanzania HIV Impact Survey (THIS).

HIV testing continues to be a challenge among the young population in Tanzania. As of 2017, only 30% of 15-19-year-olds reported getting tested and receiving their results. This study will examine the demographic and socio-behavioral characteristics associated with HIV testing among adolescents and young adults in Tanzania. Interview data from the 2016-2017 Tanzania HIV Impact Survey (THIS) were analyzed on 10,128 adolescents and young adults 15-24 years of age, representing 10.5 million youth in Tanzania. Weighted logistic regression was used to model the relationship of HIV testing with demographic and socio-behavioral characteristics. Half (50%) of respondents reported ever having been tested for HIV. HIV testing was significantly lower among males compared with females (AOR = 0.5;95% confidence interval [CI] = 0.5-0.6; p<0.001), 15-19 year olds compared with 20-24 year olds (AOR = 0.4;95% CI = 0.4-0.5; p<0.001), no education compared with secondary or post-secondary education (AOR = 0.4;95% CI = 0.3-0.6; p<0.001), rural residents compared with urban residents (AOR = 0.7;95% CI = 0.6-0.9; p<0.001) and those who don't use condoms during sexual intercourse compared with those who do (AOR = 0.6;95% CI = 0.5-0.8; p<0.001). Among HIV-infected youth, younger age group, rural residents, education less than primary, single, high income, and sex workers were significantly associated with never testing for HIV. This study highlights the majority of characteristics affecting HIV testing among young people in Tanzania have not changed over the years, thus it is necessary to re-examine the current approaches to HIV testing. The COVID-19 pandemic will add to this challenge as it collides with the ongoing HIV epidemic and competes for needed medical supplies and health care provider resources. In light of this current situation, intensified and targeted HIV testing programs for at risk young populations in Tanzania should be prioritized.

Using a Machine Learning Algorithm to Predict the Likelihood of Presence of Dental Caries among Children Aged 2 to 7.

BACKGROUND: Dental caries is the most common chronic childhood infectious disease and is a serious public health problem affecting both developing and industrialized countries, yet it is preventable in most cases. This study evaluated the potential of screening for dental caries among children using a machine learning algorithm applied to parent perceptions of their child's oral health assessed by survey. METHODS: The sample consisted of 182 parents/caregivers and their children 2-7 years of age living in Los Angeles County. Random forest (a machine learning algorithm) was used to identify survey items that were predictors of active caries and caries experience. We applied a three-fold cross-validation method. A threshold was determined by maximizing the sum of sensitivity and specificity conditional on the sensitivity of at least 70%. The importance of survey items to classifying active caries and caries experience was measured using mean decreased Gini (MDG) and mean decreased accuracy (MDA) coefficients. RESULTS: Survey items that were strong predictors of active caries included parent's age (MDG = 0.84; MDA = 1.97), unmet needs (MDG = 0.71; MDA = 2.06) and the child being African American (MDG = 0.38; MDA = 1.92). Survey items that were strong predictors of caries experience included parent's age (MDG = 2.97; MDA = 4.74), child had an oral health problem in the past 12 months (MDG = 2.20; MDA = 4.04) and child had a tooth that hurt (MDG = 1.65; MDA = 3.84). CONCLUSION: Our findings demonstrate the potential of screening for active caries and caries experience among children using surveys answered by their parents.

Evaluation of an interprofessional education program in pediatric dentistry, medicine, and nursing.

PURPOSE: The purpose of this study was to assess whether the Strategic Partnership for Interprofessional Collaborative Education in the Pediatric Dentistry (SPICE-PD) program at the UCLA School of Dentistry positively affected interprofessional experiences and practice patterns of pediatric and general dentistry residents, pediatric medical residents, and pediatric nurse practitioner students (PNPs). METHODS: Data collection included a year-end online survey given to participants in the interprofessional program upon graduation from their UCLA dental/medical/nursing programs. Of the 318 participants who were recruited into SPICE-PD, 208 (65%; 208/318) completed the survey. Chi-square tests were used to assess differences in key outcome variables by dental/medical specialty. RESULTS: Most dental, medical, and nursing participants thought SPICE-PD helped them learn to work more effectively with interprofessional colleagues and reported knowing more about the abilities and contributions of other health professionals as a result of the program. While most pediatric medical residents and PNPs thought SPICE-PD improved their skills to screen for early childhood caries (N = 91% and N = 100%), PNPs were more likely than pediatric medical residents to report SPICE-PD improved their skills to apply fluoride varnish (98% versus 72%; p < 0.001). Almost all pediatric medical residents and PNPs thought primary care providers should incorporate oral health into routine patient care and provide referrals to dental professionals when necessary. CONCLUSION: Increased interprofessional education and coordination of care through programs such as SPICE-PD can help bridge the gap between dental and medical care and lead to improved oral health outcomes and more comprehensive and preventive patient care.

A Content Analysis of How Sexual Behavior and Reproductive Health are Being Portrayed on Primetime Television Shows Being Watched by Teens and Young Adults.

Television is a leading source of sexual education for teens and young adults, thus it is important to understand how sexual behavior and reproductive health are portrayed in popular primetime programming. This study is a media content analysis of the 19 top-rated scripted English-language primetime television shows aired between January 1, 2015 and May 31, 2015, and viewed by American youth audiences 12-24 years of age. The purpose of this study is to assess how sex/sexuality and reproductive health are being portrayed in a popular medium that reaches many adolescent and young adult audiences. Themes used for this analysis include youth pregnancy/parenting, mentoring/guidance of youth regarding sexual behavior, sex/sexuality, body image/identity, sexual violence/abuse/harassment, gender identity/sexual orientation, and reproductive health. Themes have been classified in one of the following six categories: visual cues, brief mentions, dialogue, minor storylines, major storylines, and multi-episode storylines. Our findings indicate that narratives providing educational information regarding the risks and consequences of sexual behavior were missing from the television shows we analyzed and that storylines promoting low risk sexual behavior were rare. Sexual violence and abuse, casual sex among adults, lack of contraception use, or no portrayal of consequences of risky behaviors were common. Compared to prior research, we found an emergent theme normalizing non-heterosexual gender identity and sexual orientation. Our findings have important implications as exposure to popular media shapes the perceptions and behaviors of teens and young adults. This study has the potential to shed light on the need to create stories and narratives in television shows watched by American teens and young adults with educational messages regarding the risks and consequences of sexual behavior.

Effects of a Laboratory Health Information Exchange Intervention on Antiretroviral Therapy Use, Viral Suppression, and Racial/Ethnic Disparities.

BACKGROUND: Although antiretroviral therapy (ART) is available to treat HIV+ persons and prevent transmission, ineffective delivery of care may delay ART use, impede viral suppression (VS), and contribute to racial/ethnic disparities along the continuum of care. This study tested the effects of a bi-directional laboratory health information exchange (LHIE) intervention on each of these outcomes. METHODS: We used a quasi-experimental, interrupted time-series design to examine whether the LHIE intervention improved ART use and VS, and reduced racial/ethnic disparities in these outcomes among HIV+ patients (N = 1181) in a comprehensive HIV/AIDS clinic in Southern California. Main outcome measures were ART pharmacy fill and HIV viral load laboratory data extracted from the medical records over 3 years. Race/ethnicity and an indicator for the intervention (after vs. before) were the main predictors. The analysis involved 3-stage, multivariable logistic regression with generalized estimating equations. RESULTS: Overall, the intervention predicted greater odds of ART use (odds ratio [OR] = 2.50; 95% confidence interval: 2.29 to 2.73; P < 0.001) and VS (OR = 1.12; 95% confidence interval: 1.04 to 1.21; P < 0.05) in the final models that included sociodemographic, behavioral, and clinical covariates. Before the intervention, there were significant black/white disparities in ART use OR = 0.75 (0.58-0.98; P = 0.04) and VS OR = 0.75 (0.61-0.92; P = 0.001). After the intervention, the black/white disparities decreased after adjusting for sociodemographics and the number of HIV care visits, and Latinos had greater odds than whites of ART use and VS, adjusting for covariates. CONCLUSIONS: The intervention improved overall ART treatment and VS, and reduced black/white disparities. LHIE interventions may hold promise if implemented among similar patients.

Rectal Douching Prevalence and Practices Among Peruvian Men Who have Sex with Men and Transwomen: Implications for Rectal Microbicides.

Peruvian men who have sex with men (MSM) and transwomen (TW) could benefit from a rectal microbicide (RM) formulated as a rectal douche to prevent HIV infection. However, little is known about rectal douching practices among Peruvian MSM and TW, information necessary to inform RM douche development and future uptake. Using a self-administered interview, we examined the prevalence of and factors associated with rectal douching among a convenience sample of 415 Peruvian MSM and 68 TW. In the previous 6 months, 18 % of participants reported rectal douching using pre-filled commercial kits or plastic bottles or enema bags filled with water, water/soap or saltwater. Multivariate logistic analysis found that "equally insertive and receptive" or "exclusively/mainly receptive" sex roles were associated with douche use. Rectal douching among Peruvian MSM and TW is similar to reports from other studies and supports the potential uptake of a douche-formulated RM in these populations.

Using conjoint analysis to determine the impact of product and user characteristics on acceptability of rectal microbicides for HIV prevention among Peruvian men who have sex with men.

OBJECTIVES: Men who have sex with men (MSM) are in need of novel and acceptable HIV prevention interventions. In Peru, a Phase II clinical trial was recently completed evaluating rectally applied tenofovir gel among Peruvian MSM and transgender women. If deemed safe and acceptable, the product could move into efficacy testing, but acceptability data for similar products are needed now in order to prepare for future implementation. Peru is in need of expanded, national acceptability data among likely users. METHODS: Using conjoint analysis of an online cross-sectional survey taken by 1008 Peruvian MSM and transgender women, we tested the acceptability of eight hypothetical rectal microbicide (RM) products comprising six, dual-value attributes. We also assessed the relationship of select product attributes with sample characteristics. RESULTS: Highest acceptability was found for a RM that was 90% effective, used before and after sex, without side effects, costing approximately $0.30, had no prescription requirement and had a single-use applicator. Product effectiveness and presence of side effects were the factors most likely to drive RM acceptance and use. Education, sexual orientation, sexual role and concern for HIV infection were also related to aspects of RM acceptability. CONCLUSION: RM acceptability was high, confirming the results of earlier, smaller studies and placing confidence in the acceptability of RMs. Analysis of the relationships with product attributes and sample characteristics underscore the need to consider the impact of factors such as sexual orientation, sexual role, level of education and concern for HIV acquisition on RM acceptability.

Does the Centers for Disease Control and Prevention's Recommendation of Opt-Out HIV Screening Impact the Effect of Stigma on HIV Test Acceptance?

HIV/AIDS-related stigma is a key factor impeding patient utilization of HIV testing services. To destigmatize HIV testing, the Centers for Disease Control and Prevention recommended an 'opt-out' screening strategy aimed at all patients in all clinical settings, regardless of HIV risk. This study assessed whether opt-out screening as compared to opt-in screening was associated with increased uptake of HIV testing among patients with HIV/AIDS-related stigma concerns. This study included 374 patients attending two Los Angeles ambulatory care clinics. Stigma items were grouped into three constructs: Blame/isolation, abandonment, and contagion. Individuals endorsing the blame/isolation subscale (AOR = 0.52; 95 % CI 0.29-0.92; p\0.05) and abandonment subscale (AOR = 0.27; 95 % CI 0.13-0.59; p\0.01) were significantly less likely to accept an HIV test. Additionally, the opt-out model did not counter the negative effects of stigma on HIV test acceptance. These findings indicate that stigma remains a barrier to HIV testing, regardless of the opt-out screening approach.

Factors associated with visible anogenital warts among HIV-uninfected Peruvian men who have sex with men and transwomen: a cross-sectional study.

BACKGROUND: Visible, anogenital warts may be associated with risk factors for HIV infection. This cross-sectional study examined the factors associated with visible anogenital warts among HIV-uninfected Peruvian men who have sex with men (MSM) and transwomen. METHODS: Six hundred HIV-uninfected MSM and transwomen were recruited from a community-based setting in metropolitan Lima, Peru, through outreach activities. Participants were tested for syphilis, completed a behavioral questionnaire, and were examined for visible anogenital warts. Logistic regression was used to assess the independent association between sample characteristics, HIV-related risk factors, and visible anogenital warts. RESULTS: A tertiary education versus a primary/secondary (adjusted odds ratio [AOR], 1.79; 95% confidence interval [CI], 1.07-2.99), a first experience of anal intercourse at age 20 years or older versus younger ages (AOR, 2.80; 95% CI, 1.45-5.38), and self-reporting of current sexually transmitted infection symptoms (AOR, 2.38; 95% CI, 1.61-3.52) were significant correlates of visible anogenital warts, whereas syphilis infection, transactional sex, receptive anal intercourse, and self-identifying as a transwoman were not. CONCLUSIONS: Although not associated with key risk factors for HIV infection in Peruvian MSM and transwomen, the presence of visible anogenital warts should prompt clinicians to consider the possibility of unreported same-sex sexual behaviors and other risk sexually transmitted infection/HIV risk factors.

Understanding STI Risk and Condom Use Patterns by Partner Type Among Female Sex Workers in Peru.

While brothel-based sex work is regulated by the Peruvian government, there is little data on STI risk factors reported by female sex workers (FSW). This study compared high risk behaviors among 120 Peruvian FSW from government regulated brothels with both clients and non-commercial partners. Our study found that 12% of FSW reported unprotected vaginal sex with clients (compared to 75% with non-commercial partners), and 42% reported unprotected anal sex with clients (compared to 87% with non-commercial partners). Group differences were observed in the expectation to have oral sex (32% for partners vs 60% for clients; p<0.01), and a history of anal sex (65% for partners vs 32% for clients; p<0.01) and both vaginal and anal sex with the same partners (46% for partners vs 25% for clients; p<0.001). These findings suggest that FSW constitute an important bridge population for STI/HIV transmission in Peru.

Preparing for rectal microbicides: sociocultural factors affecting product uptake among potential South American users.

OBJECTIVES: We examined views on rectal microbicides (RMs), a potential HIV prevention option, among men who have sex with men and transgender women in 3 South American cities. METHODS: During September 2009 to September 2010, we conducted 10 focus groups and 36 in-depth interviews (n = 140) in Lima and Iquitos, Peru, and Guayaquil, Ecuador, to examine 5 RM domains: knowledge, thoughts and opinions about RM as an HIV prevention tool, use, condoms, and social concerns. We coded emergent themes in recorded and transcribed data sets and extracted representative quotes. We collected sociodemographic information with a self-administered questionnaire. RESULTS: RM issues identified included limited knowledge; concerns regarding plausibility, side effects, and efficacy; impact on condom use; target users (insertive vs receptive partners); and access concerns. CONCLUSIONS: Understanding the sociocultural issues affecting RMs is critical to their uptake and should be addressed prior to product launch.

Rectal douching and implications for rectal microbicides among populations vulnerable to HIV in South America: a qualitative study.

OBJECTIVE: While gel-formulated rectal microbicides (RM) are the first to enter clinical trials, rectal douching in preparation for anal intercourse is a common practice; thus RMs formulated as douches may be a convenient alternative to gels. Nonetheless, little is known about potential users' thoughts regarding douche-formulated RMs or rectal douching practices, data that is needed to inform the advancement of douche-based RMs. This qualitative study examined thoughts regarding douches, their use as an RM and current douching practices among men who have sex with men and transgender women. METHODS: 12 focus groups and 36 in-depth interviews were conducted (N=140) to examine the overall acceptability of RM, of which one component focused on rectal douching. Focus groups and interviews were recorded, transcribed verbatim and coded; text relating to rectal douching was extracted and analysed. Sociodemographic information was collected using a self-administered questionnaire. RESULTS: Support for a douche-formulated RM centred on the possibility of combined precoital hygiene and HIV protection, and it was believed that a deeply penetrating liquid douche would confer greater HIV protection than a gel. Drawbacks included rectal dryness, impracticality and portability issues, and potential side effects. Non-commercial douching apparatus use was common and liquids used included detergents, vinegar, bleach, lemon juice and alcohol. CONCLUSIONS: A douche-formulated RM, while desirable and perceived as more effective than a gel-formulated RM, also generated questions regarding practicality and side effects. Of immediate concern were the non-commercial liquids already being used that likely damage rectal epithelia, potentially increasing HIV infection risk. Precoital rectal douching is common and an RM formulated as such is desirable, but education on rectal douching practices is needed now.

Improving overweight among at-risk minority youth: results of a pilot intervention in after-school programs.

Childhood overweight and obesity disproportionately affect low-income communities. Most school-based health promotion efforts occur during the school day and are limited in scope. This study evaluated the effectiveness of an after-school program among 3rd-5th graders (n=121; 73% 8 to 9 years old; 57% female; 60% Asian) at eight study sites (four intervention, four comparison). After-school staff were trained on implementing the Catch Kids Club Curriculum on nutrition and physical activity. Data were collected on students' nutrition and physical activity knowledge and behavior, and their height and weight measurements. Using Stata 10.1/SE, cross-lagged regression models assessed changes over time. Results showed a reduction in overweight and obesity (defined as body mass index >85th percentile for age and sex) among children in the intervention group, but mixed results regarding diet and physical activity knowledge and behavior. Enhancing after-school physical activity opportunities through evidence-based programs can potentially improve overweight and obesity among low-income children.

Preference for physician vs. nurse-initiated opt-out screening on HIV test acceptance.

Provider-initiated opt-out HIV screening suggests that providers should routinely order HIV tests unless a patient declines. However, data on how providers will respond to this new screening model are scarce. Documented concerns from the providers' perspectives have included time constraints of a typical patient encounter, and discomfort with discussing sexual history and risk behavior with patients. To address these potential barriers, nurse-initiated screening has been proposed as an approach to increasing screening rates in general medical and urgent care settings. This study compares patient acceptability of provider-initiated opt-out HIV screening with nurse-initiated opt-out HIV screening among 220 patients between the ages of 18-64 from two publically funded "safety-net" outpatient clinics in Los Angeles County. Our study found that 77% of patients agreed to HIV testing using opt-out screening, and that HIV test acceptance was higher with the physician-initiated opt-out model compared with the nurse-initiated opt-out model (adjusted odds ratios = 2.92; 95% CI = 1.37-6.22). These findings indicate that adding opt-out screening to primary care providers responsibilities may be an acceptable and effective strategy for addressing the perennially low HIV testing rates, particularly among low income, traditionally underserved patient populations among whom the epidemic is expanding most rapidly.