Young Adults' Access to Insurance Through Parents: Relationship to Receipt of Reproductive Health Services and Chlamydia Testing, 2007-2014.

PURPOSE: Adolescents' concerns about confidential service receipt have been linked to avoidance of sexual and reproductive healthcare. Healthcare system changes allowing young adults to remain on a parent's health insurance plan up to age 26 may have extended these concerns to young adults. This study examines: (1) The association between the relationship of young women to primary health plan policy holder (parent or self) on receipt of reproductive health services and chlamydia screening. (2)Changes, over time, in the proportion of young women who are parentally- versus self-insured. METHODS: Cross-sectional analysis of commercially insured young women (18-25) enrolled ≥330days in health plans included in the Truven Health MarketScan commercial claims and encounters database (2007-2014). RESULTS: Between 2010 and 2014, the proportion of parentally-insured young women increased significantly across all age groups (AOR = 4.32, CI = 4.29, 4.33). Compared to self-insured young women, parentally-insured young women were less likely to receive a reproductive health service (AOR = .66, CI = .66, .67) and sexually active parentally-insured young women were less likely to receive chlamydia testing (AOR = .75, CI = .75, .76) using their parent's insurance. CONCLUSIONS: Young women who are insured through a parent are less likely to receive reproductive health services or chlamydia testing using their parent's insurance, which could suggest that concerns about confidential receipt of health services may result in missed care. Various policies, including those related to explanation of benefits sent to a plan policy holder outlining services received, may affect the receipt of confidential healthcare by young adults.

Longitudinal Examination of Aggression and Study Skills From Middle to High School: Implications for Dropout Prevention.

BACKGROUND: High school completion provides health and economic benefits. The purpose of this study is to describe dropout rates based on longitudinal trajectories of aggression and study skills using teacher ratings. METHODS: The sample consisted of 620 randomly selected sixth graders. Every year from Grade 6 to 12, a teacher completed a nationally normed behavioral rating scale. We used latent class mixture modeling to identify the trajectories. RESULTS: Participants followed 3 trajectories of aggression (Low, Medium Desisting, and High Desisting) and 5 trajectories of study skills (Low, Average-Low, Decreasing, Increasing, and High). Over three-quarters of the sample were in stable trajectories of study skills over time. Most students in the High Desisting Aggression group were in the Low Study Skills group, and all students in the High Study Skills group were in the Low Aggression group. The overall dropout rate was 17%, but varied dramatically across combined aggression and study skills groups, ranging from 2% to 50%. CONCLUSIONS: The results highlight the importance of early prevention that combines academic enhancement and behavioral management for reducing school dropout.

The Impact of the American College of Obstetricians and Gynecologists Guideline Changes in Pap Tests on Annual Chlamydia Test Rates.

PURPOSE: To assess impact of the 2009 American College of Obstetricians and Gynecologists (ACOG) Pap guideline changes on chlamydia testing rates among sexually active young women. METHODS: The study included sexually active women aged 15-25 years enrolled in commercial health plans from 2005 to 2014. We identified sexually active women by diagnosis, procedure, and drug codes in inpatient, outpatient, and drug claims databases. We identified Pap tests and chlamydia tests among sexually active adolescents (15-20 years) and young adults (21-25 years) over time. Using piecewise regression models, we compared the change in chlamydia testing rates before and after 2009 ACOG guidelines. RESULTS: From 2005 to 2014, chlamydia testing rates in sexually active women increased from 23% to 37% among adolescents and from 24% to 43% among young adults. Although the overall increase in chlamydia testing was positive, the annual rate of change in chlamydia testing (slope) decreased significantly after the 2009 ACOG guideline change from 1.9% before to 1.0% after for adolescents (p < .05) and from 2.5% to 1.7% for young adults (p < .05). CONCLUSIONS: Although chlamydia test rates are increasing among sexually active women aged 15-25 years from 2005 to 2014, the slower growth in chlamydia testing rate after 2009 may relate to the change in the Pap testing guidelines. Our finding that more than half of sexually active women aged 15-25 years did not have chlamydia testing and that the rate of increased chlamydia testing slowed after 2009 suggests that interventions to improve chlamydia testing apart from combining with Pap testing are still needed.

Trajectories of physical dating violence from middle to high school: association with relationship quality and acceptability of aggression.

Although research on dating violence is growing, little is known about the distinct developmental trajectories of dating violence during adolescence. The current study identifies trajectories of physical dating violence victimization and perpetration that boys and girls follow from sixth to twelfth grade, examines the overlap of these trajectories, and characterizes them by perceptions of a caring dating relationship and acceptability of dating aggression. The sample consisted of randomly selected sixth graders from nine schools in Northeast Georgia (n = 588; 52 % boys; 49 % White, 36 % African American, 12 % Latino) who completed yearly surveys from Grades 6-12. We used latent class mixture modeling to identify the trajectories and generalized estimating equations models to examine the acceptability of dating aggression by dating violence trajectories. Participants followed two trajectories of dating violence victimization (boys: low and high; girls: low and increasing) and two of perpetration (boys and girls: low and increasing). When examining the joint trajectories of victimization and perpetration, a similar proportion of boys (62 %) and girls (65 %) were in the low victimization and low perpetration group and reported the lowest acceptance of dating aggression. The same proportion of boys and girls (27 %) were in the high/increasing victimization and perpetration group, and reported the highest acceptance of dating aggression. However, acceptance of dating aggression decreased from Grade 6-12 for all groups, even for those whose trajectory of dating violence increased. Victimization and perpetration were associated with reporting a less caring dating relationship. Results highlight the importance of focusing prevention efforts early for adolescents who follow this increasing probability of physical dating violence.