Search

Asian American adolescents have been reported to have the lowest amount of communication with health care providers regarding sexual health topics (sexual activity, contraception, sexually transmitted infections, and pregnancy prevention). This study identified Asian American adolescents’ attitudes/beliefs regarding how health care providers can be most helpful in communicating about sexual health topics. Twenty participants revealed the following information: (a) confidentiality concerns resulted in lying to health care providers about sexual histories or refusing hormonal contraception, (b) a general lack of knowledge regarding sexual health topics, and (c) a hesitancy to discuss sexual histories with Asian American health care providers. Asian American adolescents expressed a need for privacy from parents regarding their sexual behaviors, and want health care providers to initiate conversations and provide information about sexual health topics.

We examined parental preferences in raising Spanish/English bilingual children. We identified factors influencing their decisions, and the strategies used to promote bilingualism. Focus groups were conducted with Spanish-primary-language parents of children 3 to 7 years old. These groups were audiotaped and transcribed. Three reviewers independently analyzed transcripts for themes using margin-coding and grounded theory; disagreements were resolved by consensus. Thirteen Spanish-primary-language parents participated in two focus groups. The results show that parents wanted their children to be bilingual. Parents also stated that the benefits of bilingualism included better career opportunities, and preservation of culture and native language. Family members, schools, and prior parental experiences influenced the parents’ decisions to raise bilingual children. Parents preferred English-only school classes and to teach Spanish at home. Strategies identified for raising bilingual children included reading bilingual books and having children speak only Spanish at home. Schools and pediatricians are used as resources.

Adolescent pregnancy remains a major U.S. public health problem. Little is known about pregnancy attitudes in U.S. adolescent males. The study objective was to identify factors from different domains that are associated with sexually active U.S. adolescent males who would be pleased with a female partner pregnancy (hereafter known as pleased with a pregnancy). The National Survey of Family Growth is a nationally representative survey of those 15 to 44 years old. Bivariate and multivariable analyses were performed of the 2002 and 2006-2010 cycles to examine factors associated with being pleased with a pregnancy among sexually active U.S. males. Among the 1,445 sexually active U.S. adolescent males surveyed, 25% would be pleased with a pregnancy. In bivariate analyses, ever being suspended from school, having sporadic health insurance, age, and ever HIV tested were significantly associated with being pleased with a pregnancy. In final multivariable analyses, sporadic insurance was associated with almost triple the odds, and being older and ever HIV tested with double the odds of being pleased with a pregnancy. Higher educational attainment for both adolescent males and adolescent males’ fathers was associated with reduced odds of a being pleased with a pregnancy. One quarter of sexually active U.S. adolescent males would be pleased with a pregnancy. Adolescent males who have been sporadically insured, are older, and ever HIV tested have higher odds of being pleased with a pregnancy. Targeting these adolescent males for more focused pregnancy-prevention counseling may prove useful in reducing adolescent pregnancy rates.

Background. Alternative inpatient teams are increasing, but little is known about their impact on patient care and trainee education. Purpose. To evaluate whether a hybrid hospitalist teaching service meets trainee and attending educational, clinical, support, patient-mix, autonomy, and efficiency needs. Methods. Post pediatric rotations, team members anonymously completed surveys with Likert-scale and open-ended questions. Results. In total, 78 of 80 surveys were completed. Trainees rated educational, clinical, support, and case-mix domains highly. Senior residents responded positively for autonomy, education, and opinions of hospitalists, but neutrally on leadership. Attending scores varied for efficiency, teaching, and clinical duties; the service resulted in direct observation and teaching outside of rounds, but poor delineation of roles and expectations impeded clinical task completion, teaching on rounds, and attending meetings. Conclusions. This model is a satisfying, well-accepted means of enhancing trainee education and patient care, but roles and expectations must be clearly defined to maximize efficiency and satisfaction.

Dating behaviors and sexual attitudes of Asian-American youth were examined in a cross-sectional, mixed-methods study in the context of adherence to Asian values, measured by the Asian Values Scale (AVS). In all, 31 Asian-American adolescents (age 14-18 years old) from a Houston community center were interviewed regarding dating behaviors and sexual attitudes. Almost three-fourth of adolescents dated without parental knowledge. Compared with adolescents with the lowestAVS scores, those with the highestAVS scores were significantly more likely to date without parental knowledge and date longer before sex. Many adolescents proceeded directly to single, steady, relationships. Parents permitted dating, as long as grades were maintained. Asian-American adolescents should be questioned about secret dating, sexual activity, and participation in other high-risk activities.

Background. Approximately 3.5 million U.S. schoolchildren are limited in English proficiency (LEP). Disparities in children's health and health care are associated with both LEP and speaking a language other than English at home, but prior research has not examined which of these two measures of language barriers is most useful in examining health care disparities. Objectives. Our objectives were to compare primary language spoken at home vs. parental LEP and their associations with health status, access to care, and use of health services in children. Methods. We surveyed parents at urban community sites in Boston, asking 74 questions on children's health status, access to health care, and use of health services. Results. Some 98% of the 1,100 participating children and families were of non-white race/ethnicity, 72% of parents were LEP, and 13 different primary languages were spoken at home. “Dose-response” relationships were observed between parental English proficiency and several child and parental sociodemographic features, including children's insurance coverage, parental educational attainment, citizenship and employment, and family income. Similar “dose-response” relationships were noted between the primary language spoken at home and many but not all of the same sociodemographic features. In multivariate analyses, LEP parents were associated with triple the odds of a child having fair/poor health status, double the odds of the child spending at least one day in bed for illness in the past year, and significantly greater odds of children not being brought in for needed medical care for six of nine access barriers to care. None of these findings were observed in analyses of the primary language spoken at home. Individual parental LEP categories were associated with different risks of adverse health status and outcomes. Conclusions. Parental LEP is superior to the primary language spoken at home as a measure of the impact of language barriers on children's health and health care. Individual parental LEP categories are associated with different risks of adverse outcomes in children's health and health care. Consistent data collection on parental English proficiency and referral of LEP parents to English classes by pediatric providers have the potential to contribute toward reduction and elimination of health care disparities for children of LEP parents.

Twenty-one million Americans are limited in English proficiency (LEP), but little is known about the effect of medical interpreter services on health care quality. Asystematic literature review was conducted on the impact of interpreter services on quality of care. Five database searches yielded 2,640 citations and a final database of 36 articles, after applying exclusion criteria. Multiple studies document that quality of care is compromised when LEP patients need but do not get interpreters. LEP patients' quality of care is inferior, and more interpreter errors occur with untrained ad hoc interpreters. Inadequate interpreter services can have serious consequences for patients with mental disorders. Trained professional interpreters and bilingual health care providers positively affect LEP patients' satisfaction, quality of care, and outcomes. Evidence suggests that optimal communication, patient satisfaction, and outcomes and the fewest interpreter errors occur when LEP patients have access to trained professional interpreters or bilingual providers.

To examine gaps in communication versus documentation of weight-management clinical practices, communication was recorded during primary care visits with 6- to 12-year-old overweight/obese Latino children. Communication/documentation content was coded by 3 reviewers using communication transcripts and health-record documentation. Discrepancies in communication/documentation content codes were resolved through consensus. Bivariate/multivariable analyses examined factors associated with discrepancies in benchmark communication/documentation. Benchmarks were neither communicated nor documented in up to 42% of visits, and communicated but not documented or documented but not communicated in up to 20% of visits. Lowest benchmark performance rates were for laboratory studies (35%) and nutrition/weight-management referrals (42%). In multivariable analysis, overweight (vs obesity) was associated with 1.6 more discrepancies in communication versus documentation ( P = .03). Many weight-management benchmarks are not met, not documented, or performed without being communicated. Enhanced communication with families and documentation in health records may promote lifestyle changes in overweight children and higher quality care for overweight children in primary care.