Cell Phones, Sexual Behaviors and HIV Prevalence in Rakai, Uganda: A Cross Sectional Analysis of Longitudinal Data.

Cell phones have increased communication and connection across the globe and particularly in sub-Saharan Africa-with potential consequences for the HIV epidemic. We examined the association among ownership of cell phones, sexual behaviors (number of sexual partners, alcohol use before sex, inconsistent condom use), and HIV prevalence. Data were from four rounds (2010-2016) of the Rakai Community Cohort Study (N = 58,275). Sexual behaviors and HIV prevalence were compared between people who owned a cell phone to people who did not own a cell phone. We stratified analysis by younger (15-24 years) and older (25+ years) age groups and by gender. Using logistic regression and after adjusting for sociodemographic characteristics, we found cell phone ownership was independently associated with increased odds of having two or more sexual partners in the past 12 months across age and gender groups (young men AOR 1.67, 95% CI 1.47-1.90; young women AOR 1.28 95% CI 1.08-1.53; older men AOR 1.54 95% CI 1.41-1.69; older women AOR 1.44 95% CI 1.26-1.65). Interestingly, young men who owned cell phones had decreased odds of using condoms inconsistently (AOR 0.66, 95% CI 0.57-0.75). For young women, cell phone ownership was associated with increased odds of using alcohol before sex (AOR 1.38 95% CI 1.17-1.63) and increased odds of inconsistent condom use (AOR 1.40, 95% 1.17-1.67). After adjusting for sociodemographic characteristics, only young women who owned cell phones had increased odds of being HIV positive (AOR 1.27 95% CI 1.07-1.50). This association was not mediated by sexual behaviors (Adjusted for sociodemographic characteristics and sexual behaviors AOR 1.24, 95% CI 1.05-1.46). While cell phone ownership appears to be associated with increased HIV risk for young women, we also see a potential opportunity for future cell phone-based health interventions.

Young adult US-born Latina women's thoughts, feelings and beliefs about unintended pregnancy.

Current measures of unintended pregnancy underestimate the co-occurring, complex set of social, cultural, economic and structural factors that influence how women interpret unintended pregnancy. The purpose of this study was to prospectively explore young adult US-born Latinas' thoughts, feelings and beliefs about pregnancy, specifically unintended pregnancies and the sociocultural factors identified as contributors to those beliefs. In-depth interviews (n = 20) were conducted with US-born, English-speaking Latinas aged 18-25 years in south Florida. Seventeen participants did not intend to get pregnant, while the remaining participants (n = 3) reported that their intentions kept changing. Participants' beliefs regarding their unintended pregnancy were influenced by social and economic hardship and cultural factors such as fatalism and familismo. Ideas and the meaning of pregnancy differed based on the woman's pregnancy resolution decision. Many women felt the term 'unintended pregnancy' placed blame on women and was stigmatising. When discussing pregnancy planning, most participants felt that women should not plan their pregnancies and doing so was going against fate. Findings suggest that salient influences such as culture and the social determinants related to unintended pregnancy should be incorporated into measurements examining unintended pregnancy.

Facing HIV infection and unintended pregnancy: Rakai, Uganda, 2001-2013.

BACKGROUND: Unintended pregnancy is a persistent and global issue with consequences for the health and well-being of mothers and babies. The aim of this paper is to examine unintended pregnancy over time in the context of substantial human immunodeficiency virus (HIV) prevalence and increasing access to anti-retro viral therapy (ART). METHOD: Data are from the Rakai Community Cohort Study (RCCS) - a cohort of communities with 10,000-12,000 adults, ages 15-49, in Rakai District, Uganda. We examined prevalence of current pregnancies over time, intended pregnancy, and unintended pregnancies (unwanted, mistimed, ambivalent). We then examined risk factors for the different categories of unintended pregnancy among women who were currently pregnant. The full sample included 32,205 observations over 13 years. RESULTS: The prevalence of mistimed pregnancy and unwanted pregnancy both decreased significantly over time (p < .001). The prevalence of current pregnancies and intended pregnancy showed no significant changes over the thirteen year period. The same overall pattern was found when only examining HIV positive women in the sample; however, the trends were not significant. Out of the 2820 current pregnancies reported, 54.4% were intended, 29.8% were mistimed, 13.2% were unwanted, and 2.5% were ambivalent. After controlling for other predictors, HIV status had no independent effect on mistimed pregnancy but had a significant effect on unwanted pregnancy (RRR = 2.44, 95% CI = 1.65-3.61, p < .001] and ambivalent pregnancy [RRR = 2.07; CI: 1.03 to 4.18, p = 0.041]. In 2004, after the introduction of ART, there was a decreased risk in unintended pregnancy [RR = 0.75; CI: 0.66 to 0.84, p < .001]. Women with a secondary education or higher also had a decreased risk in unintended pregnancy [RR = 0.70; CI: 0.70 to 0.92, p = 0.002]. DISCUSSION: HIV was an important predictor of unwanted pregnancy. Unintended pregnancy decreased in the sample over time which may be due to an increase in ART availability and rising levels of education.

Expect With Me: development and evaluation design for an innovative model of group prenatal care to improve perinatal outcomes.

BACKGROUND: Despite biomedical advances and intervention efforts, rates of preterm birth and other adverse outcomes in the United States have remained relatively intransigent. Evidence suggests that group prenatal care can reduce these risks, with implications for maternal and child health as well as substantial cost savings. However, widespread dissemination presents challenges, in part because training and health systems have not been designed to deliver care in a group setting. This manuscript describes the design and evaluation of Expect With Me, an innovative model of group prenatal care with a strong integrated information technology (IT) platform designed to be scalable nationally. METHODS/DESIGN: Expect With Me follows clinical guidelines from the American Congress of Obstetricians and Gynecologists. Expect With Me incorporates the best evidence-based features of existing models of group care with a novel integrated IT platform designed to improve patient engagement and support, enhance health behaviors and decision making, connect providers and patients, and improve health service delivery. A multisite prospective longitudinal cohort study is being conducted to examine the impact of Expect With Me on perinatal and postpartum outcomes, and to identify and address barriers to national scalability. Process and outcome evaluation will include quantitative and qualitative data collection at patient, provider, and organizational levels. Mixed-method data collection includes patient surveys, medical record reviews, patient focus groups; provider surveys, session evaluations, provider focus groups and in-depth interviews; an online tracking system; and clinical site visits. A two-to-one matched cohort of women receiving individual care from each site will provide a comparison group (n = 1,000 Expect With Me patients; n = 2,000 individual care patients) for outcome and cost analyses. DISCUSSION: By bundling prevention and care services into a high-touch, high-tech group prenatal care model, Expect With Me has the potential to result in fundamental changes to the health care system to meet the "triple aim:" better healthcare quality, improved outcomes, and lower costs. Findings from this study will be used to optimize the dissemination and effectiveness of this model. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02169024 . Retrospectively registered on June 18, 2014.

Group Prenatal Care Attendance: Determinants and Relationship with Care Satisfaction.

Objectives Group prenatal care results in improved birth outcomes in randomized controlled trials, and better attendance at group prenatal care visits is associated with stronger clinical effects. This paper's objectives are to identify determinants of group prenatal care attendance, and to examine the association between proportion of prenatal care received in a group context and satisfaction with care. Methods We conducted a secondary data analysis of pregnant adolescents (n = 547) receiving group prenatal care in New York City (2008-2012). Multivariable linear regression models were used to test associations between patient characteristics and percent of group care sessions attended, and between the proportion of prenatal care visits that occurred in a group context and care satisfaction. Results Sixty-seven groups were established. Group sizes ranged from 3 to 15 women (mean = 8.16, SD = 3.08); 87 % of groups enrolled at least five women. Women enrolled in group prenatal care supplemented group sessions with individual care visits. However, the percent of women who attended each group session was relatively consistent, ranging from 56 to 63 %. Being born outside of the United States was significantly associated with higher group session attendance rates [B(SE) = 11.46 (3.46), p = 0.001], and women who received a higher proportion of care in groups reported higher levels of care satisfaction [B(SE) = 0.11 (0.02), p < 0.001]. Conclusions Future research should explore alternative implementation structures to improve pregnant women's ability to receive as much prenatal care as possible in a group setting, as well as value-based reimbursement models and other incentives to encourage more widespread adoption of group prenatal care.

Food insecurity and effectiveness of behavioral interventions to reduce blood pressure, New York City, 2012-2013.

INTRODUCTION: Food insecurity is associated with diet-sensitive diseases and may be a barrier to successful chronic disease self-management. To evaluate the impact of food insecurity on blood pressure reduction in a pilot clinical trial, we tested the effectiveness of 2 behavioral interventions for hypertension in people with and without food security. METHODS: A group of 28 men and women with type 2 diabetes and uncontrolled hypertension were randomized to either 1) home blood pressure telemonitoring alone or 2) home blood pressure telemonitoring plus telephone-based nurse case management. The primary outcome was 6-month change in systolic blood pressure. RESULTS: The 2 interventions resulted in modest, nonsignificant blood pressure reductions. Food-secure patients experienced clinically and statistically significant reductions in blood pressure, whereas no significant change was seen among food-insecure patients. CONCLUSION: Screening for food insecurity may help identify patients in need of tailored disease management interventions.

The Influence of Identity on Multiracial Emerging Adults' Health and Experiences Seeking Healthcare in the United States: a Qualitative Study.

BACKGROUND: The Multiracial population, defined as having parents who are of two or more racial groups, increased from 2.9% of the United States population in 2010 to 10.2% in 2020. Existing research focused on monoracial populations shows that racial disparities and discrimination affect health. This study explores how emerging adults ages 18-29, who identify as Multiracial, describe the impact of identity on their health and experiences seeking health care in the United States. METHODS: Semi-structured interviews were conducted with 21 participants in May 2021. Interview guide categories were the following: health and wellbeing, racial/ethnic identification, childhood upbringing, family influence, peer engagement, discrimination, forming resilience, language, and demographics. A thematic framework analysis was utilized. RESULTS: Overarching themes were as follows: mental health and Multiracial identity-related stress, childhood experiences, healthcare experiences, influences on seeking or not seeking care, and the impact of identity on physical health. Our findings suggest that Multiracial emerging adults perceive their identity to influence mental health more than physical health. CONCLUSION: Multiracial emerging adults face challenges with healthcare that are unique (e.g., discrimination based on identity defined or perceived by others) and others that are similar to their monoracial counterparts (e.g., structural racism, access to care). This study illustrates how structural factors trickle down to influence care sought and accessibility via socioeconomic status, insurance, childhood experiences, and racial and cultural beliefs about healthcare. Increased awareness and identification of Multiracial individuals and diversity in the workforce may help the US healthcare system better serve Multiracial emerging adults.

The sum of all parts: A multi-level exploration of racial and ethnic identity formation during emerging adulthood.

According to the 2020 U.S. Census, the multiracial population measured at 33.8 million, nearly a 300% increase from the 2010 U.S. Census. The significant increase is due in part to improvements in measures to categorize this population. However, there is a dearth of research on the factors and processes that affect multiracial identity formation. The researchers investigated the precipitating factors to the formation of multiracial identification. Participants were recruited through social media campaigns. Hour-long in-depth interviews were conducted with 21 participants via Zoom, following an interview guide consisting of 9 categories: racial and ethnic identification, childhood and upbringing, family influence, peer engagement, health and wellbeing, experiences of discrimination, forming resilience, language, and demographics. Coding of transcripts and thematic analyses revealed that individual, interpersonal and community level influences influenced identity development differently depending on the individual's positionality within the life course. This supported the use of both the life course framework as well as the social ecological framework when examining multiracial identity development.

Effects of a Mentoring Program for Black, Indigenous, and People of Color and First-Generation Public Health Students.

OBJECTIVES: Among graduate public health students, Black, Indigenous, and other people of color (BIPOC; including Latinx, Asian, Middle Eastern and North African, Native Hawaiian and Pacific Islander, and multiracial) experience educational and personal challenges that require institutional support and reform. The objective of this study was to evaluate the effects of an antiracist mentorship program on the sense of belonging and overall experience among BIPOC and first-generation students at Columbia University Mailman School of Public Health in New York City. METHODS: We used 2 data sources to retrospectively evaluate experiences of BIPOC and first-generation graduate students: the 2021 Mentoring of Students and Igniting Community (MOSAIC) Student Survey (n = 39), which collected data on experiences of students who participated in the MOSAIC program, and the 2016-2020 Graduate Exit Surveys (n = 1222), which collected data on graduating students' experiences, satisfaction, and perspectives on diversity, equity, and inclusion. A difference-in-difference analysis compared overall experience, public health career preparedness, quality of life, and department satisfaction among all students before (2016-2018) and after (2019-2020) implementation of the MOSAIC program. RESULTS: Satisfaction among graduate students attributable to the MOSAIC program introduced in 2019 increased by about 25%. Compared with students who had not been exposed to MOSAIC, students exposed to MOSAIC had a 25% positive difference (P = .003) in overall graduate school experience, a 28% difference (P < .001) in quality of life, and a 10% difference (P = .001) in satisfaction with their departments. CONCLUSION: Mentorship for BIPOC and first-generation public health graduate students offers an effective strategy to improve student experiences and satisfaction with graduate departments and, ultimately, may help students meet educational and professional goals.

Social and Structural Influences on Multiracial Identification and Health: a Public Health Mandate to Precisely Measure, Theorize, and Better Understand Multiracial Populations.

There is a growing group of adolescents and young adults in the USA who identify as multiracial. However, very little research, especially health research, focuses on understanding multiracial identification and health and behavioral outcomes for multiracial populations in comparison to their single-race counterparts. Understanding the intersectional influences on this identification process is critical to updating the literature on racial and ethnic identity and health with more accurate identifications and categories. It is especially critical that there is an explicit focus on understanding the impact of structural racism and discrimination when studying the process of racial identification and the impact on health. This review takes an interdisciplinary approach relying on a review of multiple research literatures: the historical literature on race, racism and categorization, psychological and adolescent medicine literatures on adolescent development, the sociological literature on racial and ethnic identification, and the limited public health research beginning to disentangle multiracial health outcomes. An empirically testable conceptual framework is offered to frame the organization of this review-demonstrating the multiple spheres of influence on racial and ethnic identification and the implication for health outcomes.

Psychosocial outcomes and peer influences among multiracial adolescents in the United States.

Objective: To examine racial and ethnic self-identification among adolescents and explore psychosocial outcomes and peer treatment for multiracial adolescents in the United States. Methods: Data are from the 2014 Child Development Supplement, a subsample of the Panel Study of Income Dynamics. Data were weighted to be nationally representative. Descriptive statistics were used to describe the population and to explore family and parent demographics. Multivariable regressions tested for differences in psychosocial outcomes and peer treatment and group behaviors for multiracial youth in comparison to their single race peers. Results: Black multiracial youth had significantly lower scores on the children's depression index compared to single race Black youth, and White multiracial youth reported significantly higher rates of peer mistreatment in comparison to White single race youth. Black multiracial and White multiracial adolescents reported similar positive and negative peer group behaviors. Conclusions: Complex patterns emerge when examining the psychosocial and peer treatment variables presented in this analysis for multiracial adolescents and their single-race peers. The findings regarding depressive symptoms and peer bullying point to signs of different relationships between multiracial groups. White multiracial adolescents report worse outcomes than their White single-race peers, but Black multiracial adolescents reporting better outcomes than their Black single-race peers.

Receipt of Private Time Among Adolescents and Young Adults With and Without Special Healthcare Needs.

PURPOSE: Private time is an opportunity for the adolescent patient to speak directly to a healthcare provider and a marker of quality preventive health care. Little is known about whether adolescents and young adults (AYAs) with special healthcare needs (SHCNs) are afforded private discussions with their primary care clinicians. METHODS: We surveyed a nationally representative sample of 1,209 adolescents (13-18 years) and 709 young adults (19-26 years) about whether they had SHCNs and whether they had ever had private, one-on-one time with their healthcare providers. RESULTS: SHCNs were reported by 20.3% of adolescents and 15.6% of young adults. Among adolescents, older age was associated with more SHCNs. Among young adults, women and blacks were more likely to report SHCNs than men and those reporting other race categories. For both AYAs, those with SHCNs more often received private time than those without SHCNs: 54.2% of adolescents and 88.1% of young adults with SHCNs reported ever having received private time, compared with 29.6% of adolescents and 62.1% of young adults without SHCNs. CONCLUSIONS: Lack of private time continues to impact quality primary care for AYAs; however, AYAs with SHCNs are more likely to have received private time than AYAs who do not have SHCNs. Further research is needed to understand whether increased number of clinical visits, clinician-related factors, or other factors lead to more opportunities for young people with SHCNs to receive private time from their clinicians.

Correlates of Sexual and Reproductive Health Discussions During Preventive Visits: Findings From a National Sample of U.S. Adolescents.

PURPOSE: This study examines characteristics of healthcare delivery, providers, and adolescents associated with provider-adolescent discussions about sexual and reproductive health (SRH) during preventive visits. METHODS: Data were from a 2019 national internet survey of U.S. adolescents ages 11-17 years and their parents. Adolescents who had a preventive visit in the past 2 years (n = 853) were asked whether their provider discussed each of eight SRH topics at that visit: puberty, safe dating, gender identity, sexual orientation, whether or not to have sex, sexually transmitted infections including human immunodeficiency virus, birth control methods, and where to get SRH services. Eight multivariable logistic regression models were examined (one for each SRH topic as the outcome), with each model including modifiable healthcare delivery and provider characteristics, adolescent beliefs, behaviors, and demographic characteristics as potential correlates. RESULTS: Provider-adolescent discussions about SRH topics at the last preventive visit were positively associated with face-to-face screening about sexual activity for all eight topics (range of adjusted odds ratios [AORs] = 3.40-9.61), having time alone with the adolescent during that visit (seven topics; AORs = 1.87-3.87), and ever having communicated about confidentiality with adolescents (two topics; AORs = 1.88-2.19) and with parents (one topic; AOR = 2.73). Adolescents' perception that a topic was important to discuss with their provider was associated with provider-adolescent discussions about seven topics (AORs = 2.34-5.46). CONCLUSIONS: Findings that provider-adolescent discussions about SRH during preventive visits were associated with modifiable practices including time alone between providers and adolescents and screening about sexual activity can inform efforts to improve the delivery of adolescent SRH services within primary care.

Parents' Sources of Adolescent Sexual Health Information and Their Interest in Resources From Primary Care.

OBJECTIVE: To examine sources of information used by parents to facilitate parent-adolescent communication about sexual and reproductive health (SRH), parents' preferences for receiving SRH information through primary care, and factors associated with parents' interest in primary-care-based SRH information (ie, resources recommended or offered in the primary care setting). METHODS: In this cross-sectional study, a nationally representative sample of 11-17-year-old adolescents and their parents (n = 1005 dyads) were surveyed online; 993 were retained for these analyses. Parents were asked about their use of 11 resources to help them talk with their adolescents about SRH and rated the likelihood of using specific primary-care-based resources. We used multivariable logistic regression to examine characteristics associated with parent interest in primary-care-based SRH resources. RESULTS: Only 25.8% of parents reported receiving at least a moderate amount of SRH information from primary care; half (53.3%) reported receiving no SRH information from their adolescent's provider. Parents received the most information from personal connections (eg, spouse/partner, friends). Most parents (59.1%) reported being likely to utilize a primary-care-based resource for SRH information. Parents who previously received SRH information from primary care sources had greater odds of reporting they would be likely to utilize a primary-care-based resources (AOR = 4.06, 95% CI: 2.55-6.46). CONCLUSIONS: This study provides insights into parents' sources of information for communicating with their adolescents about SRH and ways primary care practices might increase support for parents in having SRH conversations with their adolescents. Future studies are needed to establish clinical best practices for promoting parent-adolescent communication about SRH.

HIV combination prevention and declining orphanhood among adolescents, Rakai, Uganda, 2001-18: an observational community cohort study.

BACKGROUND: Orphanhood increased markedly in the 1980s and 1990s in sub-Saharan Africa because of HIV-related mortality. Little is known about the contribution of HIV interventions, such as antiretroviral therapy (ART) and male medical circumcision, to more recent trends in orphanhood. In this study, we examined trends over time in maternal-only, paternal-only, and double orphanhood among adolescents before and after ART and male medical circumcision became widely available in the Rakai region of south-central Uganda. We sought to understand the association between adolescent orphanhood and HIV combination prevention (community-level ART use and prevalence of male medical circumcision). We hypothesised that increasing combination prevention, including greater use of ART and higher prevalence of male medical circumcision, would be associated with a lower probability of orphanhood. METHODS: We examined the prevalence of orphanhood among adolescents aged 15-19 years, before and after roll-out of ART in mid-2004 and male medical circumcision in 2007, using data from 28 continuously followed communities within the Rakai Community Cohort Study. We used multinomial logistic regression with clustered SEs to estimate adjusted relative risk ratios (RRs) for maternal-only, paternal-only, and double orphanhood compared with non-orphanhood over 11 survey rounds between 2001 and 2018. Controlling for community HIV prevalence, household socioeconomic status, and adolescent age, we examined the association between community prevalence of ART use among people living with HIV and prevalence of male circumcision, including traditional circumcision. The primary outcome was orphanhood among adolescents aged 15-19 years. FINDINGS: Orphanhood declined from 52% (920 of 1768 participants) in 2001-02 to 23% (592 of 2609 participants) by 2016-18 (p<0·0001), while double orphanhood declined from 20% (346 of 1768 participants) to 3% (86 of 2609 participants) (p<0·0001). Community prevalence of ART use among people living with HIV increased from 11% (105 of 945 participants) in 2005-06 to 78% (1163 of 1485 participants) in 2016-18. Male circumcision rates rose from 19% (147 of 790 participants) in 2005-06 to 65% (3535 of 5433 participants) in 2016-18. In the multinomial logistic regression model, a 10% increase in community prevalence of ART use was associated with a decrease in maternal orphanhood (adjusted relative RR 0·90, 95% CI 0·85-0·95) and double orphanhood (0·80, 0·75-0·85). In the post-ART era, a 10% increase in the community prevalence of male circumcision was associated with a decrease in paternal orphanhood (2005-18, adjusted relative RR 0·92, 0·87-0·97) and double orphanhood (0·91, 0·85-0·98). INTERPRETATION: Widespread availability and uptake of HIV combination prevention was associated with marked reductions in orphanhood among adolescents. Reductions in orphanhood promise improved health and social outcomes for young people. FUNDING: Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Institute of Allergy and Infectious Diseases, the National Institute of Mental Health, and the Division of Intramural Research of the National Institute for Allergy and Infectious Diseases.

Physician Perspectives on the Impact of the COVID-19 Pandemic on Family-Centered Rounds.

BACKGROUND: The coronavirus disease 2019 pandemic has required modifications to family-centered rounds (FCR), although the specific changes and the effects on patients, families, and providers are not well known. In this study, we explore physician perspectives on changes made to FCR during the initial wave of the coronavirus disease 2019 pandemic and recommendations for the future. METHODS: Semistructured individual interviews were conducted with 20 pediatric attending and resident physicians who cared for hospitalized patients between March and May 2020 on pediatric hospital medicine and subspecialty services that typically perform FCR. Transcripts were reviewed by using principles of framework analysis to iteratively develop a codebook. Review of coded segments, with attention to code co-occurrences, was used to clarify themes in the data relating to the research objective and the conceptual framework. RESULTS: The rounding format changed for all providers and varied on the basis of clinical service and phase of the pandemic. Themes highlighted specific areas of change: (1) the process of FCR, (2) reaching consensus with families, (3) collaboration with members of the medical team, and (4) resident education, modeling, and supervision. Participants offered recommendations, including standardization of rounds, intentional involvement of nursing staff, and inclusion of families through virtual or small-group bedside rounds. CONCLUSIONS: The pandemic led to a variety of modifications to FCR, and these changes had varied effects on communication and education. These findings provide insight into the state of FCR during the pandemic and may frame future recommendations for the development of shared guidelines for circumstances requiring limited bedside rounding.

Columbia COVID-19 Student Service Corps: Harnessing student skills and galvanizing the power of service learning.

The COVID-19 pandemic in New York City led to the forced rapid transformation of the medical school curriculum as well as increased critical needs to the health system. In response, a group of faculty and student leaders at CUIMC developed the COVID-19 Student Service Corps (Columbia CSSC). The CSSC is an interprofessional service-learning organization that galvanizes the skills and expertise of faculty and students from over 12 schools and programs in the response to the COVID-19 pandemic, and is agile enough to shift and respond to future public health and medical emergencies. Since March 2020, over 30 projects have been developed and implemented supporting needs identified by the health system, providers, faculty, staff, and students as well as the larger community. The development of the CSSC also provided critical virtual educational opportunities in the form of service learning for students who were unable to have any in-person instruction. The CSSC model has been shared nationally and nine additional chapters have started at academic institutions across the country.

Sexual and Reproductive Health Discussions During Preventive Visits.

OBJECTIVES: To quantify adolescent- and parent-perceived importance of provider-adolescent discussions about sexual and reproductive health (SRH), describe prevalence of provider confidentiality practices and provider-adolescent discussions about SRH topics during preventive visits, and identify missed opportunities for such conversations. METHODS: We used data from a national Internet survey of 11- to 17-year-old adolescents and their parents. Data were weighted to represent the noninstitutionalized US adolescent population. Adolescents who had a preventive visit in the past 2 years and their parents reported on perceived importance of provider-adolescent discussions about SRH topics: puberty, safe dating, gender identity, sexual orientation, sexual decision-making, sexually transmitted infections and HIV, methods of birth control, and where to get SRH services. Adolescents and parents reported whether they had ever discussed confidentiality with the adolescent's provider. Adolescents reported experiences at their most recent preventive visit, including whether a provider spoke about specific SRH topics and whether they had time alone with a provider. RESULTS: A majority of adolescents and parents deemed provider-adolescent discussions about puberty, sexually transmitted infections and HIV, and birth control as important. However, fewer than one-third of adolescents reported discussions about SRH topics other than puberty at their most recent preventive visit. These discussions were particularly uncommon among younger adolescents. Within age groups, discussions about several topics varied by sex. CONCLUSIONS: Although most parents and adolescents value provider-adolescent discussions of selected SRH topics, these discussions do not occur routinely during preventive visits. Preventive visits represent a missed opportunity for adolescents to receive screening, education, and guidance related to SRH.