Risk of Delayed Human Papillomavirus Vaccination in Inner-City Adolescent Women.

BACKGROUND: Uptake of human papillomavirus (HPV) vaccine in the United States is slow, and the effectiveness of the vaccine has not been assessed in high-risk adolescent populations. METHODS: We conducted a longitudinal study of 1139 sexually active, inner-city adolescent women receiving the 3-dose quadrivalent (4vHPV) vaccine. Cervical and anal specimens collected semiannually were tested using an L1-specific polymerase chain reaction assay. Postvaccination incidence of 4vHPV vaccine and nonvaccine HPV types, and risk of cervical cytological abnormalities, were assessed in relation to time to completion of all 3 vaccine doses. RESULTS: Compared to vaccine naive women at enrollment, vaccinated women had significantly lower incidence rate ratios of cervical infection with HPV6/11/16/18 (0.2; 95% confidence interval [CI], .1-.4) and the related types HPV31 and HPV45 (0.4 [95% CI, .2-1.0] and 0.3 [95% CI, .1-.6], respectively), as well as significantly lower incidence rate ratios of anal infection with HPV6/11/16/18 (0.4; 95% CI, .2-.7). Notably, we observed higher risks of cervical HPV6/11/16/18 infection (hazards ratio [HR], 2.9; 95% CI, 1.0-8.0) and associated cytological abnormalities (HR, 4.5; 95% CI, .7-26.0) among women immunized at ≥15 years of age who took ≥12 months (vs <12 months) to complete the 3-dose regimen. CONCLUSIONS: Among adolescents immunized at ≥15 years of age, a longer time to complete the 3-dose schedule was associated with an increased risk of anogenital HPV6/11/16/18 infection and an increased incidence of associated cervical cytological abnormalities.

Distinct Ecological Niche of Anal, Oral, and Cervical Mucosal Microbiomes in Adolescent Women.

Human body sites represent ecological niches for microorganisms, each providing variations in microbial exposure, nutrient availability, microbial competition, and host immunological responses. In this study, we investigated the oral, anal, and cervical microbiomes from the same 20 sexually active adolescent females, using culture-independent, next-generation sequencing. DNA from each sample was amplified for the bacterial 16S rRNA gene and sequenced on an Illumina platform using paired-end reads. Across the three anatomical niches, we found significant differences in bacterial community composition and diversity. Overall anal samples were dominated with Prevotella and Bacteriodes, oral samples with Streptococcus and Prevotella, and cervical samples with Lactobacillus. The microbiomes of a few cervical samples clustered with anal samples in weighted principal coordinate analyses, due in part to a higher proportion of Prevotella in those samples. Additionally, cervical samples had the lowest alpha diversity. Our results demonstrate the occurrence of distinct microbial communities across body sites within the same individual.

Administration of Childhood Physical and Childhood Sexual Abuse Screens in Adolescents and Young Adults: a Literature Review.

BACKGROUND: Childhood physical and sexual abuse can have a negative impact on adolescents and young adults. Although effective interventions that can ameliorate both the short- and long-term negative impacts are available, many adolescent and young adult victims remain without help: They rarely self-identify as victims, and health care providers generally fail to inquire about a history of childhood abuse, especially in the absence of physical signs. The health care field lacks an understanding of effective methods for the identification of childhood abuse. OBJECTIVES: To address this knowledge gap, this paper focuses on a systematic review of the literature for studies comparing modes of administration of measures to identify a history of childhood physical and sexual abuse in adolescents and young adults. METHODS: A systematic review of the literature published in English in peer-reviewed journals between January 1, 1994, and December 31, 2014 was conducted to identify studies that compared 2 or more modes of administration using the same measure to identify a history of childhood physical and sexual abuse in adolescent and young adult populations. Studies that compared 2 or more different measures for identifying abuse were not included in this review because the focus of the review was to isolate the effects of the mode of administration. FINDINGS: Only 1 study that met review criteria was found. It was conducted among female college students in a university setting. No studies were identified that compared modes of administration used to elicit disclosure of a history of childhood abuse among adolescents. CONCLUSIONS: There remains an urgent need to conduct evaluations of methods to identify childhood physical and sexual abuse including the mode of administration of screens in young people. It is recommended that future studies include diverse populations and randomized and quasi-experimental approaches.

Comparison of Modes of Administration of Screens to Identify a History of Childhood Physical Abuse in an Adolescent and Young Adult Population.

BACKGROUND: Childhood physical abuse is a major public health issue with negative consequences to health and well-being manifested in childhood and adolescence, and persisting into adulthood. Yet much childhood physical abuse is not identified when it occurs and little is known about how to screen for it. METHODS: To address this gap, the effectiveness of 4 modes of administration of screens to identify childhood physical abuse were compared in a sample of 506 adolescents and young adults aged 12-24 years seeking general health services at a primary care clinic. Comparisons were made between paper and pencil screen, audio computer-assisted self-interview screen, face-to-face structured screen (all 3 using the same measure), and face-to-face unstructured interview. FINDINGS: Overall, 44.5% of the sample disclosed that they had been physically abused. Compared to paper and pencil screen, the odds of reporting physical abuse were 1.5 (95% confidence interval [CI]: 0.92, 2.58) and 4.3 (95% CI: 2.49, 7.43) higher among participants using face-to-face structured screen and face-to-face unstructured interview methods, respectively. The face-to-face unstructured interview identified significantly more reports than the paper and pencil screen. CONCLUSIONS: Although the unstructured interview was the most effective mode for screening for childhood physical abuse, additional research is needed to confirm whether this holds true in other health care settings. Further research should examine how a health provider's training, experience, and comfort level might influence the identification of physical abuse disclosure in primary care settings using face-to-face unstructured interview.

Health Care Use and Status Among Abused Young People.

BACKGROUND: Childhood abuse negatively affects young people's health. Little is known about its effect on health care usage patterns or on perception of health status during a life stage when learning to use care independently is a key developmental task. OBJECTIVES: In nonclinical study settings, abuse has been found to be associated with disorganized use of care and perceived poorer health. Our objective was to determine whether abused youth receiving health care had similar outcomes. METHODS: This observational study, conducted between December 5, 2005 and April 13, 2007, screened for childhood abuse in 532 young people seeking services at a primary care clinic. The setting was a New York City young people's free health clinic. Participants were aged 12-24 years, recruited during a visit, mostly female (86%), Latino or black (94%), and currently in school or college (79%). Exclusions included not being fluent in English or having difficulty understanding the study/consent process. RESULTS: Health care use (routine vs urgent care) in the prior 12 months and perceived health status were measured using the Health Service Utilization Scale. Potential demographic covariates were controlled for, as was depression (using the Beck Depression Inventory for Primary Care-Fast Screen). A total of 54% disclosed abuse. Compared with those who were not abused, those reporting sexual abuse had 1.4 times greater odds of choosing both urgent and routine care over routine care only. Those reporting any type of abuse had lower odds of selecting urgent care only over routine care. No association was found between childhood abuse and perceived health status. CONCLUSIONS: In contrast to studies conducted among youth in nonclinic settings, in this study childhood abuse was not associated with health care usage patterns or with poorer perception of health. Further research is needed regarding the impact receiving health care has on perceived health and health care use in abused youth. Annals of Global Health 2017;0:000-000.

Association Between Cumulative Psychosocial Risk and Cervical Human Papillomavirus Infection Among Female Adolescents in a Free Vaccination Program.

OBJECTIVE: This study investigated the association of cervical human papillomavirus (HPV) infection with cumulative psychosocial risk reflecting family disadvantage, psychological distress, and unhealthy lifestyle. METHODS: The sample (N = 745) comprised sexually active female adolescent patients (12-19 yr), primarily ethnic minorities, enrolled in a free HPV vaccination program. Subjects completed questionnaires and provided cervical swabs for HPV DNA testing. Unweighted and weighted principal component analyses for categorical data were used to derive multisystemic psychosocial risk indices using 9 indicators: low socioeconomic status, lack of adult involvement, not attending high school/college, history of treatment for depression/anxiety, antisocial/delinquent behavior, number of recent sexual partners, use of alcohol, use of drugs, and dependency risk for alcohol/drugs. The association between cervical HPV (any type, high-risk types, vaccine types) assayed by polymerase chain reaction and self-reported number of psychosocial risk indicators was estimated using multivariable logistic regression. RESULTS: Subjects had a median of 3 psychosocial risk indicators. Multiple logistic regression analyses showed associations with unweighted and weighted number of psychosocial indicators for HPV any type (adjusted odds ratio [aOR] = 1.1; 95% confidence interval [CI], 1.0-1.2), with the strongest associations between weighted drug/alcohol use, drug/alcohol dependency risk, and antisocial/delinquent behavior and detection of HPV vaccine types (aOR = 1.5; 95% CI, 1.1-2.0) independent of number of recent sexual partners and vaccine dose (0-3). CONCLUSION: Increased HPV infections including HPV vaccine types were associated with greater number of psychosocial risk indicators even after controlling for demographics, sexual behavior, history of chlamydia, and vaccine dose.

A research agenda for adolescent-centered primary care in the United States.

Little attention has been given to how primary care can be transformed to better meet the needs of adolescents. To help generate the evidence needed, The National Alliance to Advance Adolescent Health convened an invitational conference in 2012 in Washington, DC. Participants from various disciplines identified a set of prioritized recommendations pertaining to 3 topics: increasing adolescent and parent engagement and self-care management; improving preventive care and identifying conditions early; and integrating physical, behavioral, and reproductive health services. This commentary includes the top three recommendations for each topic area and concludes with a brief examination of federal and private funding prospects.

Cervical, anal and oral HPV in an adolescent inner-city health clinic providing free vaccinations.

OBJECTIVES: Published human papillomavirus (HPV) vaccine trials indicate efficacy is strongest for those naive to the vaccine-types. However, few high-risk young women have been followed and cervical HPV has been the predominant outcome measure. METHODS: We collected cervical and anal swabs, as well as oral rinse specimens from 645 sexually active inner-city young females attending a large adolescent health-clinic in New York City that offers free care and HPV vaccination. Specimens were tested for HPV-DNA using a MY09/MY11-PCR system. Type-specific prevalence of HPV at each anatomic site was compared for individuals by vaccination dose using generalized estimating equation logistic regression models. RESULTS: The majority of subjects reported being of non-Caucasian (92%) and/or Hispanic ethnicity (61%). Median age was 18 years (range:14-20). All had practiced vaginal sex, a third (33%) practiced anal sex, and most (77%) had also engaged in oral sex. At enrollment, 21% had not received the vaccine and 51% had received three doses. Prevalent HPV infection at enrollment was detected in 54% of cervical, 42% of anal and 20% of oral specimens, with vaccine types present in 7%, 6% and 1% of specimens, respectively. Comparing prevalence for vaccine types, the detection of HPV in the cervix of vaccinated compared to unvaccinated adolescents was significantly reduced: HPV6/11 (odds ratio [OR] = 0.19, 95%CI:0.06-0.75), HPV16 (OR = 0.31, 95%CI:0.11-0.88) and HPV18 (OR = 0.14, 95%CI:0.03-0.75). For anal HPV, the risk of detecting vaccine types HPV6/11 (OR = 0.27, 95%CI:0.10-0.72) and HPV18(OR = 0.12, 95%CI:0.01-1.16) were significantly reduced for vaccinated adolescents however, the risk for HPV16 was not significantly decreased (OR = 0.63, 95%CI:0.18-2.20). CONCLUSION: HPV Prevalence is extremely high in inner-city female adolescents. Administration of the HPV vaccine reduced the risk for cervical HPV; however continued follow-up is required to assess the protection for HPV at all sites in young women with high exposure.

Capacity-building for youth workers through community-based partnerships.

Although positive youth development (PYD) is increasingly influential in the field of youth programming, core knowledge and competencies for youth workers continue to be defined. Youth serving agencies throughout the United States face serious obstacles in the creation of a stable and well-trained workforce, despite the presence of many talented and resourceful individuals who work with youth in the community. One strategy for organizational and staff development is through PYD-oriented, community-based partnerships designed to enhance youth worker knowledge and competence. Two different partnerships are described in this report. The first brought together experts in youth work, health, and trauma, and focused on improving youth worker response to psychologic trauma commonly experienced by urban youth. This partnership used an iterative reflective practice approach to describe best practices in youth work. The second partnership strategically taught evaluation skills to youth program consumers, AmeriCorps service members, and adult youth workers to advance youth-adult partnerships. These exemplars demonstrate that partnerships can drive systems for improving competencies in youth workers and the capacities of youth services.