Examining the Role of Childhood Adversity on Excess Alcohol Intake and Tobacco Exposure among US College Students.

BACKGROUND: Adverse childhood experiences (ACEs) are often associated with substance use behaviors such as drinking excess alcohol and tobacco use. Resilience may protect individuals from engaging in these maladaptive behaviors following ACEs. Objectives: We examined the associations between ACEs and excessive alcohol consumption, and ACEs and tobacco intake and exposure among diverse college students, and whether resilience buffered this relationship. Methods: We conducted a cross-sectional online survey in October 2018 with students at a large Southern university to assess ACEs, levels of resilience, and students' health behaviors. We used the Adverse Childhood Experiences - International Questionnaire (ACE-IQ) and the Brief Resilience Scale. Logistic regression modeled the relationship between ACEs and students' substance use behaviors. We adjusted for demographics, other health behaviors, and emotional health and we tested resilience as a possible buffer. Results: Participants (n = 568) were in their early twenties, almost three-fourths were female. We had a racially/ethnically diverse sample. Over two-thirds had experienced 1-4 ACEs. ACE exposure was not associated with excess alcohol consumption but exhibited a consistent dose-response relationship in unadjusted and adjusted models. Moderate ACEs increased the odds of tobacco exposure by 227% (OR: 3.27, 95% CI: 1.17-9.11) in adjusted models. Resilience was unrelated to either behavior. Black respondents had significantly reduced odds for both substance use outcomes. Tobacco exposure and excess alcohol intake were comorbid behaviors. Conclusion: Childhood adversity was a significant predictor for tobacco exposure among diverse US college students. Resilience did not buffer this relationship. Age, gender, and race/ethnicity were differentially associated with substance use.

Patient-centered communication: dissecting provider communication.

PURPOSE: The purpose of this paper is to examine the relationship between patients' provider communication effectiveness and courteousness with patients' satisfaction and trust at free clinics. DESIGN/METHODOLOGY/APPROACH: This cross-sectional survey (n=507), based on the Consumer Assessment of Healthcare Providers and Systems instrument, was conducted in two Southeastern US free clinics. Latent class analysis (LCA) was used to identify patient subgroups (clusters) with similar but not immediately visible characteristics. FINDINGS: Across the items assessing provider communication effectiveness and courteousness, five distinct clusters based on patient satisfaction, trust and socio-demographics were identified. In clusters where communication and courteousness ratings were consistent, trust and satisfaction ratings were aligned with these domains, e.g., 54 percent rated communication and courteousness highly, which was associated with high patient satisfaction and trust. When communication effectiveness and courteousness ratings diverged (e.g., low communication effectiveness but high courteousness), patient trust and satisfaction ratings aligned with communication effectiveness ratings. In all clusters, the association was greater for communication effectiveness than for provider courteousness. Thus, provider courteousness was important but secondary to communication effectiveness. PRACTICAL IMPLICATIONS: Investment in patient-centered communication training for providers will improve patient satisfaction and trust. ORIGINALITY/VALUE: The study is the first to examine individual provider communication components and how they relate to patient satisfaction and trust in free clinics. LCA helped to more fully examine communication constructs, which may be beneficial for more nuanced quality improvement efforts.

Translation and pilot testing of a measure to assess hypertension self-care activities among Hispanics.

OBJECTIVE: Hispanics in the US have high rates of uncontrolled hypertension in comparison to non-Hispanic whites. This pilot study reports on the translation of a validated measure, the Hypertension Self-Care Activity Level Effects (H-SCALE), for use with Spanish speakers. The H-SCALE assesses Hispanics' adherence to lifestyle activities that contribute to primary and secondary risk reduction of high blood pressure. DESIGN: Cross-sectional data were collected from Hispanic primary care patients attending a free health clinic in Charlotte, NC. We performed basic psychometric tests and calculated descriptive statistics to assess adherence rates to recommended hypertension self-care behaviors. RESULTS: Participants were primarily female, under age 50 and had a high-school education or less; 48% were from Mexico. Internal consistency of all H-SCALE subscales was acceptable to good. Most participants were non-smokers (80%) and alcohol abstainers (85%). Participants had low adherence to weight management practices, physical activity and healthy eating habits. One-third of those with hypertension were adherent to medication regimens. CONCLUSION: The Spanish version of the H-SCALE is a reliable and useful tool for clinicians working with Hispanic adults. Based on these findings, all adult Hispanics need lifestyle behavior counseling for primary and secondary prevention of hypertension and other chronic diseases. The H-SCALE can provide valuable information to clinical and public health practitioners focused on chronic disease prevention and management.

Pediatric Inpatient Nurses' Perceptions of Child Maltreatment.

PURPOSE: The purpose of this study was to explore the perceptions of child maltreatment among inpatient pediatric nurses. DESIGN AND METHODS: A cross-sectional survey was used to obtain responses to an online survey designed to examine perceptions of child maltreatment from inpatient pediatric nurses. RESULTS: Many nurses surveyed (41.25%) indicated that they had not received adequate training or had never received training on child maltreatment identification and many (40%) also indicated they were not familiar with the applicable reporting laws. CONCLUSIONS: Due to the serious immediate and long term effects of child maltreatment, it is imperative that pediatric inpatient nurses have adequate training on how to identify potential abuse and neglect cases, as well as legal reporting requirements, since they are in a unique position to identify potential cases of maltreatment. PRACTICE IMPLICATIONS: There is a continuing need for training on child maltreatment identification and reporting laws for inpatient pediatric nurses.

Hispanics' Satisfaction with Free Clinic Providers: An Analysis of Patient-Centered Medical Home Characteristics.

Hispanic Americans are less likely to be insured and they experience cultural and linguistic barriers that may prevent them from obtaining necessary and preventive healthcare. Adoption of Patient Centered Medical Home (PCMH) concepts in healthcare settings utilized by Hispanics could improve Hispanic patients' satisfaction with their healthcare providers. This study examined the association between Spanish-speaking and non-Spanish-speaking patients' perceptions of PCMH characteristics and satisfaction with the provider. Data were collected using a self-administered survey from two unaffiliated free clinics. Logistic regression modeled the associations between patients' perceptions of PCMH and their satisfaction with their provider, and their desire to see the same provider in the future. The sample consisted of 367 adults; 44 % were Spanish-speaking. Spanish-speaking patients were younger, less educated, and had fewer chronic conditions than non-Spanish-speaking patients. In adjusted analyses for each population, better ratings of the provider's communication skills were associated with increased satisfaction with the provider (Spanish-speaking: OR = 8.33, 95 % CI = 2.19-31.76; non-Spanish-speaking: OR = 31.39, 95 % CI = 6.91-142.62), and willingness to see the provider again (Spanish-speaking: OR = 12.54, 95 % CI = 2.80-56.24; non-Spanish-speaking: OR = 8.77, 95 % CI = 2.40-31.96). Among Spanish-speakers, lower perceived discrimination was associated with 137 % increased odds and higher perceived staff helpfulness had 212 % increased odds of seeing the provider again. Relative to other PCMH components, interpersonal skills were the most important factors in patient satisfaction with free clinics. Increased training for clinicians on cultural competence and clinician-patient communication may lead to improved patient satisfaction for both Spanish and non-Spanish speakers seen at free clinics, particularly clinics in states without Medicaid expansion.

The Association Between Maternal Depression During Pregnancy and Adverse Birth Outcomes: A Retrospective Cohort Study of PRAMS Participants.

Women of reproductive age are at higher risk for depression than men; and depressive behaviors and endocrine imbalances could lead to adverse birth outcomes. The purpose of this study was to investigate whether maternal depression during pregnancy affected adverse birth outcomes, specifically preterm birth and small for gestational age (SGA). This study included 4123 women who participated in the 2009-2011 Utah Pregnancy Risk Assessment Monitoring System, an ongoing surveillance project that investigates maternal behaviors in women who have recently had a live birth. Women self-reported information on depression and outcome data were obtained from birth certificates. Logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs). Women who self-reported a diagnosis of depression during pregnancy had statistically significant increased odds of preterm birth as compared to women who had not been diagnosed with depression (OR 1.51; 95% CI 1.07, 2.12); there was no association between depression and SGA (OR 0.92; 95% CI 0.63, 1.34). After adjustment for prenatal care visits, the depression-preterm birth association was attenuated and no longer statistically significant (OR 1.29; 95% CI 0.90, 1.85). After adjustment for smoking, there continued to be no strong association between depression and SGA (OR 0.80; 95% CI 0.54, 1.20). The findings of this study do not support a maternal depression-adverse birth outcomes relationship among a predominantly healthy population of non-Hispanic White, well educated women. Future studies should focus on other diverse populations of women to determine if there is an association for these subgroups.

Race, socioeconomic status, health-related quality of life, and self-care of type 2 diabetes mellitus among adults in North Carolina.

OBJECTIVES: The objective of this study was to examine the associations among race, education, income, and health-related quality of life (HRQoL) in self-care of type 2 diabetes mellitus among adults in North Carolina. METHODS: A secondary analysis was conducted using data from the 2009 Behavioral Risk Factor Surveillance Survey (BRFSS), a large population-based survey (N = 432,607) conducted in the United States. The data were analyzed to account for the weighted complex multistage sampling design of the Behavioral Risk Factor Surveillance Survey. Parametric testing using univariate/bivariate/multivariate analysis was performed. RESULTS: The majority of participants reported taking a class/course on diabetes mellitus management and having checked their blood glucose levels at least once per day. The majority (61.26%) of the participants did not have good self-management skills, based on the education and blood glucose-monitoring criteria established for this study. Participants with poor HRQoL had significantly increased odds of good diabetes mellitus self-care practices. CONCLUSIONS: Individuals with poor HRQoL had significantly increased odds of good diabetes mellitus self-care practices. Although findings on race, education, and income were not statistically significant, they were consistent with previous research. In the future, individuals who are nonwhite, have less than a high school level of education, and have no health insurance should be targeted to improve diabetes mellitus self-care practices through educational and informational materials. Further investigation using more comprehensive measures of diabetes mellitus self-care is warranted.

Is breakfast skipping associated with physical activity among U.S. adolescents? A cross-sectional study of adolescents aged 12-19 years, National Health and Nutrition Examination Survey (NHANES).

OBJECTIVE: To examine the association between breakfast skipping and physical activity among US adolescents aged 12-19 years. DESIGN: A cross-sectional study of nationally representative 2007-2008 National Health and Nutrition Examination Survey (NHANES) data. SETTING: Breakfast skipping was assessed by two 24 h dietary recalls. Physical activity was self-reported by participants and classified based on meeting national recommendations for physical activity for the appropriate age group. Multiple logistic regression analysis was used to model the association between breakfast skipping and physical activity while controlling for confounders. SUBJECTS: A total of 936 adolescents aged 12-19 years in the USA. RESULTS: After adjusting for family income, there was no association between breakfast skipping and meeting physical activity guidelines for age among adolescents aged 12-19 years (OR = 0.95, 95% CI 0.56, 1.32). CONCLUSIONS: Findings from the study differ from previous research findings on breakfast skipping and physical activity. Therefore, further research that uses large, nationally representative US samples and national recommended guidelines for physical activity is needed.

The association between contraceptive use at the time of conception and hypertensive disorders during pregnancy: a retrospective cohort study of prams participants.

Each year approximately 7 % of women experience hypertensive disorders during pregnancy which can result in adverse events for both the mother and child. Previous research suggests that contraception at the time of conception can also predispose one to hypertensive disorders during pregnancy. The objective of this study was to examine the association between contraceptive use at the time of conception and hypertensive complications during pregnancy. A total of 2,395 women aged 18-45 years participated in the 2007-2009 Michigan Pregnancy Risk Assessment Monitoring System. Contraception at the time of conception was self-reported by participants and classified as barrier, nonbarrier, or non-use. Information on hypertensive disorders during pregnancy was primarily from birth certificates. Logistic regression was used to obtain odds ratios (ORs) and 95 % confidence intervals (CIs) to model the contraception-hypertensive disorder association. After adjustment for age and race/ethnicity, there was no strong association between use of barrier contraception at the time of conception and hypertensive disorders during pregnancy as compared to non-users (OR 1.09, 95 % CI 0.62-1.92). After adjustment for the same variables, nonbarrier users had 1.22 times the odds of experiencing hypertensive disorders during pregnancy as compared to non-users (95 % CI 0.75-1.98). Although we did not find an association between contraceptive use at the time of conception and hypertensive disorders during pregnancy, additional studies with larger sample sizes and more explicit categorization of the outcome variable are needed to confirm these findings.

Racial influences on diabetes management among adults in North Carolina.

OBJECTIVE: To examine the impact race and socioeconomic status (SES) has on diabetes management among adults in North Carolina. DESIGN: Our study utilized data from the 2008 BRFSS to conduct a retrospective study and secondary data analysis. To account for the multistage survey design of BRFSS, SAS/SUDAAN was used to calculate adjusted and unadjusted odds ratios and 95% confidence intervals (CIs). Multiple regression analysis was performed to examine the impact race and SES has on diabetes management among North Carolina adults. RESULTS: The majority of the participants (63.34%) did not have good diabetes management based on the education and blood glucose criteria of our study. Non-Whites had higher odds than Whites to have good diabetes management practices (OR = 1.56, CI: 1.19, 2.03). Individuals who were low SES had poorer diabetes management than individuals who were identified as being high SES (OR = .81, CI: .60, 1.09). CONCLUSIONS: Disparities in good diabetes management practices were found among the variables of race, and SES. Findings from the study indicate that non-White adults had higher odds of good diabetes management practices than Whites in North Carolina. The results of this study could be used for policies and recommendations for health organizations. If health insurance policies required diabetes education classes a reduction in diabetes complications may be observed. Future studies should have a more accurate measurement of diabetes management; proxy measures were used in this study that relied on self-report and may not have provided the best measurement for diabetes management.

Effects of social ties on self-rated physical health among African American adults.

OBJECTIVES: To examine associations between social ties and self-rated physical health among midlife and older African Americans. METHODS: Cross-sectional analysis of the 2005-2006 Milwaukee African American oversample of the second Midlife Development in the United States (MIDUS II) study. Multivariate logistic regression examined associations between type of social ties (family or friends), their frequency (number of contacts), and their quality (support and strain) with betterself-rated physical health (SRPH). We defined better SRPH to include self-reports of good, very good, or excellent SRPH: this category was compared with fair or poor SRPH. Control variables included demographic factors; social engagement characteristics such as working, volunteering, and caregiving; and measures of social structure such as types of discrimination experience and ratings of neighborhood quality. RESULTS: In adjusted results, each additional degree of family support was associated with better self-rated physical health (odds ratio [OR], 1.59; 95% confidence interval (CI], 1.14-2.22). Each additional reported incident of daily discrimination was associated with 9% lower odds of reporting better SRPH (OR, 0.91; CI, 0.83-0.99). DISCUSSION: Results suggest quality of family support may contribute importantly to the health of African Americans. When working with midlife and older African Americans, providers should engage and support families as a vital resource to improve health.

A pilot study of the adverse childhood experiences-dimensions questionnaire (ACE-DQ): Associations with depression.

BACKGROUND: Recent ACE research proposed items to assess ACE dimensions, such as the frequency or timing of adverse events, that can be added to the original ACE-Study Questionnaire. OBJECTIVE: The goal of our study was to pilot-test the refined ACE-Dimensions Questionnaire (ACE-DQ) to determine its predictive validity and compare scoring approaches. PARTICIPANTS AND SETTING: Cross-sectional online survey via MTurk with U.S. adults to collect data on the ACE-Study Questionnaire and the newly developed ACE dimension items, and mental health outcomes. METHODS: We compared ACE exposure by assessment approach and their associations with depression outcomes. We used logistic regression to compare the predictive validity of different ACE scoring approaches for depression outcomes. RESULTS: Participants (n = 450) were on average 36 years old, half were female, and the majority was White. Almost half reported depressive symptoms; approximately two-thirds had experienced ACEs. Participants reporting depression had significantly higher ACE scores. Using the ACE index, participants with ACEs were 45 % more likely to report depression symptoms than participants without ACEs (OR 1.45, 95%CI 1.33-1.58). When using perception-weighted scores, participants had smaller, yet significant odds of reporting depression outcomes. CONCLUSIONS: Our results suggest that the ACE index may overestimate the impact of ACEs and the effects of ACEs on depression. Adding the comprehensive set of conceptual dimensions to more fully weigh participants' experience of adverse events can increase the accuracy of ACE measurement but will also increase participant burden considerably. We recommend including items to assess a person's perception of each adverse event for improved screening efforts and in research focused on cumulative adversity.

The association between self-efficacy and hypertension self-care activities among African American adults.

Chronic disease management requires the individual to perform varying forms of self-care behaviors. Self-efficacy, a widely used psychosocial concept, is associated with the ability to manage chronic disease. In this study, we examine the association between self-efficacy to manage hypertension and six clinically prescribed hypertension self-care behaviors. We interviewed 190 African Americans with hypertension who resided in the greater metropolitan Charlotte area about their self-efficacy and their hypertension self-care activities. Logistic regression for correlated observations was used to model the relationship between self-efficacy and adherence to hypertension self-care behaviors. Since the hypertension self-care behavior outcomes were not rare occurrences, an odds ratio correction method was used to provide a more reliable measure of the prevalence ratio (PR). Over half (59%) of participants reported having good self-efficacy to manage their hypertension. Good self-efficacy was statistically significantly associated with increased prevalence of adherence to medication (PR = 1.23, 95% CI: 1.08, 1.32), eating a low-salt diet (PR = 1.64, 95% CI: 1.07-2.20), engaging in physical activity (PR = 1.27, 95% CI: 1.08-1.39), not smoking (PR = 1.10, 95% CI: 1.01-1.15), and practicing weight management techniques (PR = 1.63, 95% CI: 1.30-1.87). Hypertension self-efficacy is strongly associated with adherence to five of six prescribed self-care activities among African Americans with hypertension. Ensuring that African Americans feel confident that hypertension is a manageable condition and that they are knowledgeable about appropriate self-care behaviors are important factors in improving hypertension self-care and blood pressure control. Health practitioners should assess individuals' self-care activities and direct them toward practical techniques to help boost their confidence in managing their blood pressure.

Satisfaction and discontinuation of contraception by contraceptive method among university women.

This study examined the association between contraceptive method and satisfaction and discontinuation. Few studies have examined these issues in the university setting and how they may potentially impact unintended pregnancy rates. This study examined data from 172 college women aged 18-36 years enrolled in the Study on Contraceptive Knowledge in Students, a cross-sectional study conducted at a large, public university. Logistic regression was used to model the association between current type of contraceptive method used (non-coital dependent vs. coital dependent) and satisfaction as well as previous type of contraceptive method used and discontinuation of that method. Nearly 80% of contracepting women currently used a non-coital dependent method. After adjustment for age, race, and location where contraception was obtained, current non-coital dependent users were significantly more likely to be satisfied with their contraceptive method compared to women using coital dependent methods (OR = 4.73, 95% CI: 1.64, 13.63). After adjustment for age, race, and history of pregnancy, women who used non-coital dependent methods of contraception were 91% less likely to have discontinued their method compared to women who used coital dependent methods (OR = 0.09, 95% CI: 0.04, 0.20). Healthcare workers and public health professionals can counsel women on using contraceptive methods that best suit their needs. By doing so, patient satisfaction and consistent contraceptive use may improve and lead to a decrease in unintended pregnancies.

Prevalence rates of hypertension self-care activities among African Americans.

BACKGROUND: A comprehensive understanding of the self-care activities that contribute to blood pressure control may explain health disparities experienced by African Americans with hypertension. This study assessed the prevalence of self-care activities among African Americans with high blood pressure and examined differences between adherers and nonadherers to self-care activities. METHODS: Interviews were conducted with 186 African Americans. Self-care activities were measured using the H-SCALE (Hypertension Self-Care Activity Level Effects), which was developed to assess the behavioral activities recommended for optimal management of high blood pressure. RESULTS: More than half of participants reported adhering to medication recommendations and prescribed physical activity levels (58.6% and 52.2%, respectively). Following practices related to weight management was less frequent, (30.1%) and adherence to low-salt diet recommendations was also low (22.0%). Three-fourths were nonsmokers and 65% abstained from alcohol. Across the self-care activities, adherers were more likely to be older and female. Nonadherers were more likely to be uninsured. CONCLUSIONS: Many African Americans still face challenges related to hypertension self-care, particularly with weight management and salt reduction. The H-SCALE was a valid and reliable measure of hypertension self-care activities. In addition to monitoring blood pressure, health care providers should assess patients' hypertension self-care activities using the H-SCALE.

The dimensionality of adverse childhood experiences: A scoping review of ACE dimensions measurement.

OBJECTIVE: Despite extensive research, the concept of adverse childhood experiences (ACEs) is not fully developed and there is low agreement on how the concept should be defined and measured. The purpose of this study was to 1) identify different conceptual dimensions associated with ACEs, such as timing or frequency; and 2) determine how these dimensions have been operationalized and analyzed to this point, in order to advance the conceptual understanding of ACEs. METHODS: We conducted a scoping review of empirical journal articles on ACEs published after the original ACE-Study in 1998 to summarize the use of dimensions for the 10 conventional ACE domains. We used a PRISMA methodology to identify articles that assessed at least two of the 10 conventional ACE domains and at least two ACE dimensions. A standardized data extraction spreadsheet was used to record basic article information and specifics on ACE domains and dimensions. RESULTS: Of 15,417 initial search results, 61 articles met all selection criteria. We identified four primary dimensions used for most ACE domains: frequency, timing, perception, and the role of the perpetrator. Additionally, we found several secondary and domain-specific dimensions, which relate to the intensity of the adverse event. DISCUSSION: We identified the most commonly used ACE dimensions, but these lack standardized phrasing of items and response options. The inclusion of ACE dimensions may increase the accuracy of the association between ACEs and health outcomes and provide for more tailored treatment plans for people who have experienced ACEs. Future research should include a more comprehensive list of ACE domains and aim to develop a clearly articulated, standardized approach to assessing and analyzing ACE dimensions.

Universal Design for Measurement: Centering the Experiences of Individuals With Disabilities Within Health Measurement Research.

People with disabilities comprise roughly 25% of the U.S. adult population yet remain underrepresented in mainstream public health and evaluation research. The lack of measures of common constructs that are validated in but not specific to this population may impede their inclusion. This article describes the use of Universal Design for Measurement (UDM), a novel method for developing self-report measurement instruments validated among broad populations to minimize the need for scale adaptation. We applied UDM to the development and content validation of a new body image scale. We assessed content validity by surveying subject matter experts (SMEs) and conducted a Delphi panel study to assess consensus about scale items among community women with (n = 18) and without (n = 15) disabilities. Most scale items were found acceptable by SMEs and community women. The Delphi panel study was useful toward evaluating consensus about scale items among women with and without disabilities. Findings support the use of UDM in developing inclusive and psychometrically sound measurement scales to ultimately facilitate the full inclusion of people with disabilities within health research.

Primary care providers' sources and preferences for cognitive health information in the United States.

In most countries, physicians and other health-care providers play key roles in promoting health. Accumulating scientific evidence suggests that providers may soon want to include cognitive health among the areas they promote. Cognitive health is the maintenance of cognitive abilities that enable social connectedness, foster a sense of purpose, promote independent living, allow recovery from illness or injury and promote effective coping with functional deficits. The US Centers for Disease Control and Prevention has established health promotion about cognitive health as a policy priority, with health providers included as one key group to participate in this effort. This study presents results from focus groups and interviews with primary care physicians (n = 28) and midlevel health-care providers (physician assistants and nurse practitioners, n = 21) in three states of the US. Providers were asked about their sources of information on cognitive health and for their ideas on how best to communicate with primary care providers about research on cognitive health. In results, providers cited online sources, popular media and continuing medical education as their most common sources of information about cognitive health. Popular media sources were used both proactively and reactively to respond to patient inquiries. Differences in sources of information were noted for physicians as compared with midlevel providers, and for rural and urban providers. Several potential ways to disseminate information about cognitive health were identified. Effective messaging is likely to require multiple strategies to reach diverse groups of primary care providers, and to include continuing medical education.

The Association Between Childhood Adversity and Self-Rated Physical Health in US College Students.

PURPOSE: Adverse childhood experiences (ACEs) are related to unhealthy behaviors and poor self-rated health. Poor self-rated physical health (SRPH) is negatively associated with college students' grades and overall academic achievement. This study examined the effects of ACEs on SRPH among undergraduate and graduate students (n = 568; 18-30 years) from a public university in the southeast. METHODS: Students completed a cross-sectional online survey in October 2018. We conducted unadjusted and adjusted logistic regressions to examine the relationship between ACEs and SRPH among US college students. RESULTS: Most participants reported 1 to 4 ACEs; one-fourth reported poor SRPH. Higher ACE exposure increased the odds for poor SRPH in a curvilinear relationship. Unadjusted results indicate ACE exposure increased risk between 82% and 228%, and that higher levels of resilience and adherence to diet and physical activity guidelines reduced risk for poor SRPH. In adjusted models, moderate ACE exposure was associated with 2.46 times greater odds (95% CI = 1.28-9.34) of reporting poor SRPH. Graduate students (odds ratio [OR] = .52, 95% CI = .27-.99) and those who met healthy diet (OR = .12, 95% CI = .02-.93) and physical activity recommendations (OR = .36, 95% CI = .23-.58) had reduced odds of poor SRPH. CONCLUSIONS: Students who have experienced ACEs are at a greater risk for poor health. Student health programs on campus should take a holistic approach by screening students for childhood adversity and promoting healthy behaviors to improve physical health.

The Relationship between Patient-Centered Medical Home Characteristics and Patient Dissatisfaction at a Federally Qualified Health Center.

This cross-sectional study examined the relationship between patients' assessment of patient-centered medical home (PCMH) characteristics and patient experiences at a federally qualified health center. The survey was based on the Consumer Assessment of Health care Providers and Systems (CAHPS) instrument. Patient-centered medical home characteristics include access to care and coordination, provider communication, office staff helpfulness, and discrimination. Outcomes were related to patient experiences reflecting their dissatisfaction and lack of trust. Our sample (N = 257) was 76% female, 39% older than 50, 40% with college education, and 84% African American. We performed multiple logistic regression to examine the association between PCMH characteristics and patient dissatisfaction, adjusting for demographics. Approximately 26% of the participants reported dissatisfaction with at least one outcome. Effective provider communication was the primary contributor to decreased odds of patient dissatisfaction and lack of trust. The study highlights the prominence of provider communication for patients using safety-net providers.