Supporting Patient-centered Communication on Adolescent Sexual and Reproductive Health-Perspectives to Build an Appointment Planning Tool.

STUDY OBJECTIVE: Input from adolescents and healthcare providers is needed to develop electronic tools that can support patient-centered sexual and reproductive (SRH) care. This study explores facilitators and barriers to patient-centered communication in the context of developing an electronic appointment planning tool to promote SRH communication in clinic settings. DESIGN: In-depth interviews were conducted to explore what constitutes adolescent-friendly SRH care and communication, as well as on the design of the appointment planning tool. Interviews were coded iteratively, and analyzed using the software Atlas.TI v8. SETTING: An adolescent primary care clinic, and a pediatric and adolescent gynecology clinic. PARTICIPANTS: Adolescent girls (N=32; ages 14-18) and providers who care for adolescent girls (N=10). MAIN OUTCOME MEASURES: Thematic analyses explored facilitators/barriers to SRH communication and care and preferences for the tool. RESULTS: Facilitators identified by adolescents and providers included: direct patient/provider communication; adolescent-driven decision-making regarding care and contraceptive choice; supplementing clinic visits with electronic resources; and holistic care addressing physical, mental, and social needs. Barriers identified by participants included: limited time for appointments; limited adolescent autonomy in appointments; and poor continuity of care when adolescents cannot see the same provider. Given the complexity of issues raised, adolescents and providers were interested in developing an appointment planning tool to guide communication during appointments, and contributed input on its design. The resulting Appointment Planning Tool app pilot is in progress. CONCLUSIONS: Qualitative interviews with adolescents and providers offer critical insights for the development and implementation of mobile health (mHealth) tools that can foster patient-centered care.

Brain-based limitations in attention and secondary task engagement during high-fidelity driving simulation among young adults.

Distracted driving remains a leading factor in fatal motor vehicle crashes, particularly in young drivers. Due to ongoing neuromaturation, attention capabilities are changing and improving throughout young adulthood. Here, we sought to bridge neuroscience with driving simulation by evaluating the effects of driving on attention processing through a selective auditory attention task. Participants (18-25 years old) engaged in an auditory attention task during LOAD (driving a high-fidelity simulator) and No-LOAD conditions (sitting in the parked simulator). For the auditory task, participants responded to a target auditory tone in a target ear. The event-related potential components, collected from frontal and posterior regions, P2 and P3, were used to evaluate attention processing across LOAD and No-LOAD conditions for attended and unattended stimuli. Data from 24 participants were evaluated in repeated measures ANOVAs, considering interactions between load and attention conditions for the P2 and P3 components of the cortical region. We observed a significant difference between response to attended and unattended stimuli for posterior P2 and P3 responses at the frontal and posterior midline sites. Comparing LOAD and No-LOAD conditions, there was a significant difference for P2 response at the posterior site and P3 response at the frontal site. A significant interaction between load and attended stimuli was found for P3 response at the posterior site. These data document differences in neural processing of auditory stimuli during high-fidelity simulated driving versus sitting parked in the simulator. Findings suggest the cognitive load of driving affects auditory attention.

Incidence of genital warts in adolescents and young adults in an integrated health care delivery system in the United States before human papillomavirus vaccine recommendations.

BACKGROUND: Information on genital wart incidence in adolescents and young adults before human papillomavirus (HPV) vaccination is important for understanding the impact of the vaccine on the epidemiology of this early outcome of HPV infection. METHODS: The study population included 11- to 29-year-old enrollees of Northern California Kaiser Permanente between July 1, 2000, and July 1, 2005, before the availability of the HPV vaccine. We identified genital warts with an algorithm combining genital wart-specific International Classification of Diseases, Ninth Revision, Clinical Modification codes (078.10, 078.11, and 078.19) with physician-recorded anatomic locations. We calculated sex- and age-specific incidence rates of genital warts and described the specific anatomic location of presentation, as well as recurrences of genital warts. RESULTS: We identified 1,682 cases of genital warts among 181,264 individuals. The incidence rate was highest among women (6.3/1000 person-years) and men (2.9/1000 person-years) aged 20 to 24 years old. Among women (n = 96,792), 63.4% of the 1240 incident genital wart cases occurred on the vulva and 21.1% on the cervix. Among men (n = 84,472), 91.6% of the 442 incident genital wart cases did not have a specific anatomic location recorded. Most people with an incident genital wart diagnosis (87.2%) did not have a recurrence during the observation period. CONCLUSIONS: Our study found that the incidence of genital warts was highest among persons aged 20 to 24 years using a unique method to identify the location of the wart. Information on incidence of genital warts before vaccine use provides baseline data that can be used to measure HPV vaccine impact.