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Objectives The uptake and actual use of the current guidelines from the American College of Obstetrics and Gynecology (ACOG) is unknown. Methods Family planning providers across Colorado and Iowa were surveyed as part of statewide initiatives to reduce unintended pregnancy in 2010 and 2012, both before and after the release of the guidelines. These initiatives focused on the promotion of intrauterine devices (IUDs) and implants. These surveys included questions on providers' views regarding the suitability and safety of the copper T IUD, hormonal IUD, and single rod implant for various subgroups of clients. The results are contrasted with guidelines provided in July of 2011 by ACOG. This strategy provides both baseline and follow-up models about the methods promoted in these guidelines. Results Findings show that there is some improvement in beliefs that IUDs are suitable and safe for women who are post-partum, post-abortion, have had an ectopic pregnancy, are nulliparous, teenagers, or have a history of STIs. However, these clinicians' views are not entirely in alignment with ACOG recommendations in their beliefs that these methods should not be used immediately post-partum or post-abortion. Notable percentages of these clinicians were hesitant to recommend these effective methods for other groups of patients, approved for use by ACOG. Conclusions While the cost of these methods is a barrier to adoption, these data suggest that there are continuing provider barriers to their use as well. The paper concludes with suggestions for further training for family planning providers. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to examine factors that are associated with tooth loss in older adults living in the San Luis Valley (SLV), Colorado, which is a rural and large geographical area (roughly the size of Connecticut) that has a large population age 60 years or older. Data used in this manuscript were collected as a part of the SLV Community Health Survey. The analyzed sample included 308 adults over the age of 65 years who completed the survey. Basic descriptive statistics and a series of step-wise binary logistic regression analyses were conducted; the dependent variable was the number of permanent teeth removed because of tooth decay or gum disease. Fifty-two percent of the participants were male, Hispanic participants made up 40 % of the sample and 76 % of the participants had at least a high school education. Tooth loss was significantly associated with older age ( OR = 1.09; p = 0.02), lower income ( OR = 0.01; p = 0.00), less than high school education ( OR = 0.32; p = 0.01), being Hispanic ( OR = 2.15; p = 0.05), self-reported fair-poor health status (OR 2.94; p = 0.02), consumption of one or more than one sweet beverage per day ( OR = 4.52 ; p = 0.00), no dental insurance ( OR = 4.70; p = 0.01) and length of time since last dental visit ( OR = 0.21; p = 0.01). The findings of the present study suggest possible causes for tooth loss in rural adults and underscore the need for in-depth research to study the overall oral health of rural older adults living in SLV. [ABSTRACT FROM AUTHOR]

The Study to Explore Early Development (SEED) is a multi-site case-control study designed to explore the relationship between autism spectrum disorder (ASD) phenotypes and etiologies. The goals of this paper are to (1) describe the SEED algorithm that uses the Autism Diagnostic Interview-Revised (ADI-R) and Autism Diagnostic Observation Schedule (ADOS) to classify children with ASD, (2) examine psychometric properties of different ASD classification methods, including the SEED method that incorporates rules for resolving ADI-R and ADOS discordance, and (3) determine whether restricted interests and repetitive behaviors were noted for children who had instrument discordance resolved using ADI-R social and communication scores. Results support the utility of SEED criteria when well-defined groups of children are an important clinical or research outcome. [ABSTRACT FROM AUTHOR]

A transdisciplinary approach incorporating biological, psychological, behavioral, and genetic factors was taken to better identify proposed moderators of the effectiveness of an intervention to increase physical activity. This paper illustrates how theory-based individual difference variables can be integrated into a complex randomized controlled trial. The transdisciplinary framework guiding the selection of moderators, the COSTRIDE intervention study and sample, and the relationships among baseline variables are provided. Participants were non-active individuals randomly assigned to either the STRIDE exercise or health-and-wellness contact control condition. Structural equation modeling was utilized to demonstrate that relationships among baseline variables confirm hypothesized relationships in the transdisciplinary framework. Preliminary data from COSTRIDE suggest that interventions among sedentary individuals may be more effective if a broader range of factors influencing physical activity are considered. [ABSTRACT FROM AUTHOR]

Background: Counseling on access to lethal means is highly recommended for patients with suicide risk, but there are no formal evaluations of its impact in real-world settings.Objective: Evaluate whether lethal means assessment reduces the likelihood of suicide attempt and death outcomes.Design: Quasi-experimental design using an instrumental variable to overcome confounding due to unmeasured patient characteristics that could influence provider decisions to deliver lethal means assessment.Setting: Kaiser Permanente Colorado, an integrated health system serving over 600,000 members, with comprehensive capture of all electronic health records, medical claims, and death information.Participants: Adult patients who endorsed suicide ideation on the Patient Health Questionnaire-9 (PHQ-9) depression screener administered in behavioral health and primary care settings from 2010 to 2016.Interventions: Provider documentation of lethal means assessment in the text of clinical notes, collected using a validated Natural Language Processing program.Measurements: Main outcome was ICD-9 or ICD-10 codes for self-inflicted injury or suicide death within 180 days of index PHQ-9 event.Results: We found 33% of patients with suicide ideation reported on the PHQ-9 received lethal means assessment in the 30 days following identification. Lethal means assessment reduced the risk of a suicide attempt or death within 180 days from 3.3 to 0.83% (p = .034, 95% CI = .069-.9).Limitations: Unmeasured suicide prevention practices that co-occur with lethal means assessment may contribute to the effects observed.Conclusions: Clinicians should expand the use of counseling on access to lethal means, along with co-occurring suicide prevention practices, to all patients who report suicide ideation. [ABSTRACT FROM AUTHOR]

Foreign-born youth have a lower risk of sexual initiation than native born youth, yet most research has focused on Latinos. An ethnically diverse sample of 200, 14-21 year-old youth were surveyed in Denver in 2014. We used logistic regression models to predict the odds of intentions to have sex and sexual experience, adding covariates that could account for differences in outcomes by immigrant generation. First generation youth were less likely to intend to have sex and to have sexual experience than third generation youth after controlling for racial/ethnic group, suggesting that first generation immigrants of multiple racial/ethnic groups, not just Latinos alone, have a lower risk for sexual initiation. Having a supportive community reduced the odds of sexual intentions and sexual experience. Our findings support future research using a larger sample of black, white, and Asian immigrant youth to corroborate and to explore reasons behind these associations. [ABSTRACT FROM AUTHOR]

Purpose Mental health issues in perinatal adolescents are well documented and studies have shown high rates of depressive disorders among this population. Treatment is challenging because pregnant adolescents are poorly adherent with mental health services. We describe a novel integrated mental health care program for pregnant and parenting adolescent mothers and their children. Methods The Colorado Adolescent Maternity Program (CAMP) is a comprehensive, multidisciplinary teen pregnancy and parenting medical home program serving an ethnically diverse and low socioeconomic status population in the Denver metro area. We describe the Healthy Expectations Adolescent Response Team (HEART), an embedded mental health care program focused on improving identification of mental health symptoms and increasing rates mental health treatment in adolescent mothers. Results From January 1, 2011-January 16 2014, 894 pregnant adolescents were enrolled in CAMP and 885 patients were screened for mental health issues. Prior to HEART's inception, 20 % of patients were identified as having mood symptoms in the postpartum period. Successful referrals to community mental health facilities occurred in only 5 % of identified patients. Following the creation of HEART, 41 % of patients were identified as needing mental health services. Nearly half of the identified patients (47 %) engaged in mental health treatment with the psychologist. Demographic factors including age, parity, ethnicity, and parent and partner involvement did not have a significant impact on treatment engagement. Trauma history was associated with lower treatment engagement. Conclusion Our findings suggest that an embedded mental health program in an adolescent obstetric and pediatric medical home is successful in improving identification and engagement in mental health treatment. Key components of the program include universal screening, intensive social work and case management involvement, and ready access to onsite mental health care providers. Limitations of the program are discussed as well directions for future research. [ABSTRACT FROM AUTHOR]

In response to the high co-occurrence of anxiety symptoms in youth with autism spectrum disorder (ASD), several interventions have been developed for this population. In spite of promising findings, some youth with ASD respond only minimally to such interventions. To understand potential factors that may impact treatment response, the current study explores the role of parental anxiety in youth treatment outcome. Thirty-one youth with ASD, ages 7-18, and their parents participated in the study. Parents completed the State/Trait Anxiety Inventory pre- and post-treatment. Contrary to previous research, there was no correlation between parental anxiety and youth anxiety at baseline or post-treatment. However, parental trait anxiety significantly decreased from pre- to post-treatment for parents of treatment responders. The findings are consistent with previous research and suggest a youth-to-parent influence. [ABSTRACT FROM AUTHOR]

We evaluated whether, among persons with type 2 diabetes: (1) impaired executive cognitive functioning (ECF) is more common than among people without diabetes; (2) ECF is associated with the capacity to engage in instrumental health-related behaviors; and (3) worse ECF is associated with increased health services utilization. A population-based sample of 1,063 older people was interviewed regarding medical history and health services utilization; participants were administered the Mini Mental State Exam and the Behavioral Dyscontrol Scale, a measure of ECF. Participants with diabetes performed more poorly on cognitive measures than those without diabetes. Among those with diabetes, lower ECF was associated with more outpatient care and with ever having been in a nursing home. Impaired behavioral self-regulation may affect the capacity to engage in behaviors that could improve clinical status, resulting in greater health services use. The findings suggest the possibility of a positive feedback loop, with ECF deficits adversely affecting adherence, in turn leading to greater cognitive impairment-an issue for future research. [ABSTRACT FROM AUTHOR]

As part of the National HIV Behavioral Surveillance System among men who have sex with men (MSM) in Denver, Colorado, we assessed knowledge of pre-exposure prophylaxis (PrEP); willingness to use PrEP; and potential changes in risk behaviors among HIV-negative participants reporting sexual activity with a male partner in the preceding 12 months. We examined knowledge of PrEP before (2008) and after (2011) results of the iPrEx trial were available. Of the 425 participants in the 2008 sample, 91 (21 %) were aware of PrEP compared to 131 (28 %) of the 461 participants in the 2011 sample (adjusted prevalence ratio: 1.43, 95 % confidence interval: 1.18, 1.72). Despite the increase in 2011, few MSM in Denver were aware of PrEP. Educating high-risk MSM about the potential utility of PrEP as an adjunct to other effective prevention methods is needed when considering the addition of PrEP to the HIV prevention arsenal. [ABSTRACT FROM AUTHOR]

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Health-related quality of life (HRQOL) is a widely accepted measure of illness state that is related to morbidity and mortality. Findings from various populations show that women report lower HRQOL than men. We analyzed baseline HRQOL data for gender differences from a multisite, randomized controlled study for adults with bipolar disorder. HRQOL was assessed using the 12-item Short Form (SF-12) physical component summary (PCS) and mental component summary (MCS) health scales. Multivariate linear and bivariate regression models examined differences in self-reported data on demographics, depressive symptoms (nine-item Patient Health Questionnaire), bipolar disorder symptoms (Internal State Scale), and medical comorbidities. Out of 384 enrolled (mean age = 42 years), 256 were women (66.7 %). After controlling for sociodemographic characteristics and clinical factors, women had lower SF-12 PCS scores than men [β = −1.78, standard error (SE) = 0.87, p < 0.05], indicating worse physical health, but there were no gender differences in MCS scores. After controlling for patient factors including medical and behavioral comorbidities, the association between gender and PCS score was no longer significant. Of the medical comorbidities, pain was associated with lower PCS scores (β = −4.90, SE = 0.86, p < 0.0001). Worse physical HRQOL experienced by women with bipolar disorder may be explained by medical comorbidity, particularly pain, suggesting the importance of gender-tailored interventions addressing physical health conditions. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine typically-developing adolescents' perceived relationship quality with their developmentally-disabled sibling, specifically siblings diagnosed with an autism spectrum disorder (ASD) or Down syndrome (DS). The 119 eleven through seventeen-year-old adolescent participants ( M = 13.32, SD = 1.90) completed an online survey that assessed demographics, sibling relationship quality, and anxiety. Results showed that siblings of children with DS have a greater overall sibling relationship quality than do siblings of children with an ASD. Results further indicated that reporting more negative interchanges within the sibling relationship was related to higher levels of anxiety regardless of sibling disability type. Lastly, sibling relationship quality moderated the relation between sibling disability type and anxiety. These findings promote greater understanding of the sibling dynamic in families with children with developmental disabilities and suggest the need for establishing more research and greater clinical evaluation in this area. Furthermore, the current study suggests that therapeutic intervention to address the sibling relationship quality within children diagnosed with ASDs and their typically-developing siblings would be beneficial in order to increase social support within the relationship as well as decrease the amount of negative interchanges within the sibling relationship. Results also suggested that decreasing the amount of negative interchanges within the sibling relationship may decrease the level of anxiety the typically-developing sibling reports. [ABSTRACT FROM AUTHOR]

Most people living with HIV/AIDS (PLWHA) disclose their serostatus to their sexual partners and take steps to protect their partners from HIV. Prior research indicates that some PLWHA portray themselves to their sexual partners as HIV-negative or otherwise misrepresent their HIV status. The aim of this study was to document the prevalence of misleading sexual partners about HIV status and to identify factors associated with misleading. A sample of 310 PLWHA completed a self-administered questionnaire assessing demographic information, disclosure, HIV knowledge, HIV altruism, psychopathy, and sexual risk behavior. Participants were also asked 'Since you were diagnosed as having HIV, have you ever misled a sexual partner about your HIV status?' Overall, 18.6% of participants indicated that they had misled a sexual partner. Those who had misled a partner at some point since their diagnosis reported more current HIV transmission risk behaviors, including unprotected anal or vaginal sex with a partner who was HIV-negative or whose HIV status was unknown. Participants who had misled a partner did not differ from those who had not in terms of demographic characteristics. Individuals who had misled a partner scored significantly lower on a measure of HIV knowledge than those who had not misled a partner. HIV altruism and psychopathy were associated with sexual risk behavior, but did not differ between those who had misled and those who had not. Disclosure of HIV status can reduce HIV transmission, but only if people are candid. Interventions aimed at increasing knowledge and accurate disclosure may reduce the spread of HIV. [ABSTRACT FROM AUTHOR]

This study focused on psychological correlates of child maltreatment histories among male adolescent offenders (N = 123). Four assessment strategies employed to assess four types of maltreatment revealed that approximately 81.9% of offenders had been exposed to at least one type of maltreatment; the majority had experienced multiple types. Multiple maltreatment positively predicted reactive aggression and dissociative symptoms; these relationships were stronger than relationships with traditional Posttraumatic Stress Disorder (PTSD) symptoms. The significant relationship between multiple maltreatment and reactive aggression was fully mediated by dissociative symptoms and partially mediated by PTSD symptoms. We discussed the use of complex trauma models to guide assessments of and interventions with adolescent offenders who had been traumatized by multiple types of maltreatment. [ABSTRACT FROM PUBLISHER]

This self-report study of 404 incarcerated youth found extraordinarily high rates of sexual minority status (SMS; i.e., lesbian/gay or bisexual) among the girls, particularly girls of color. Further analyses of the 107 girls 16 and older found that SMS girls reported being the victims of abuse and engaging in self-harming behaviors more than non-SMS (straight) girls. Structural equation models indicated that regardless of sexual identity, abuse was a risk factor for self-harming. This relationship held for physical or sexual abuse and for abuse by family members or people outside the family. Relative to non-SMS girls, SMS girls demonstrated higher rates of sexual abuse, primarily family sexual abuse, which mediated the relationship between SMS and self-harming. [ABSTRACT FROM PUBLISHER]