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We found attendance at sexually transmitted disease trainings 4 hours or more, trainees' functional role, and stated intention to change predicted actual change in sexually transmitted disease clinical practice. We also report trainees' barriers to change., Background Sexually transmitted disease clinical training for working professionals requires substantial time and resources. Understanding the predictors of change in worksite practices and barriers to change will allow educators, learners, and clinical leadership to aid in ensuring learned practices are implemented and barriers are addressed. Methods Data for this analysis come from the first standardized national evaluation of a Centers for Disease Control and Prevention–funded clinical prevention training network, including precourse registration and responses to immediate postcourse (1–3 days) and 90-day postcourse evaluations from 187 courses. Univariate statistics describe the trainees and their workplace. Bivariate statistics describe their intention to change and actual change stratified by functional role and employment setting. Logistic regression identified predictors of self-reported changes in practice. Results The strongest predictors for practice change included an intention to change and attendance at a training lasting 4 hours or more. Functional role was a weaker predictor of change in practice; employment setting did not predict change. More than half of the trainees (65.9%; n = 912) stated their intention to make a change in their practice immediately after training. At 90 days after a course, 62.4% (n = 863) reported making a practice change. Trainees that took courses lasting 4 hours or more reported making a change more often (70%) compared with trainees from shorter courses (53%). We also report on trainees’ barriers to practice change. Conclusions Results suggest that longer trainings may result in more practice change than shorter trainings, recruitment of trainees should focus on those more likely to make a change in their practice, and future trainings should focus on organizational capacity building and assessing change at the organizational level.

In this chapter, we follow a young Latina woman named Lourdes as she attempts to balance her own aspirations for a career with her own growth as a young adult in a new sexual relationship. Neither she nor her partner know enough about contraception to take steps they think are important to avoid having children right now. Her solution is one that is growing increasingly common—she combines participation in a face-to-face youth development program with a text-messaging program to carefully consider and choose the contraceptive option that is most appropriate for her. Lourdes’ story offers a case study of a growing number of sexual and reproductive health programs that include or may exclusively use mobile and digital technologies such as smartphones to communicate critical information about contraception. We explore the Youth All Engaged! (YAE!) Text messaging curriculum, developed as a series of text messages intended to supplement and enhance face-to-face curricula on sexual health. Specifically, we investigate whether a particular dose of the YAE! program is more beneficial to increase adoption of contraception and avoidance of pregnancy. Looking at data from 854 14–18 year old youth participating in the YAE! program in addition to a face-to-face youth development program sponsored by the Boys & Girls Clubs of Metropolitan Denver, we learned that youth who participated less frequently in face-to-face sessions but engaged with YAE! text messages had greater self-efficacy for condom use; this finding did not extend to youth with greater in-person participation. Given the almost universal use of cell phones among youth, we believe there is ample opportunity to reach them using text messages to support sexual health. The data from this case study suggest that text messaging can be beneficial, particularly for youth who may not be able to participate as fully in face-to-face sexual health interventions.

Using in-depth interviews, this paper explores the nature and sources of cancer-specific distress among 51 posttreatment adult leukemia and lymphoma survivors (LLS), focusing on the role of lifespan stage in shaping reported stressors. LLS (all ages) reported physical aftereffects of cancer treatment, with reported sources of emotional and financial distress varying by lifespan stage. Young adult survivors (18-39) reported a greater number of distress sources. Distress may persist up to 4 years posttreatment, particularly among younger LLS, who appear to be at greater risk of distress in multiple domains.

This paper examines predictors of cancer-specific distress among posttreatment adult leukemia and lymphoma survivors (LLS). Using a survey mailed to LLS in the Colorado Central Cancer Registry (N = 477), the authors developed a multivariable risk profile for distress. Thirty one percent of LLS reported indicators of distress. Significantly higher distress was associated with younger age (p < 0.001) in bivariate analyses. The risk profile included fear of recurrence, financial burden, and younger age. Distress did not attenuate based on time since treatment completion and may persist up to 4 years posttreatment, suggesting a need for intervention, particularly among high-risk LLS.

The purpose of this study was to investigate the fe asibility of using Clinical Emotional Freedom Techn iques (EFT) to treat Major Depressive Disorder in an adul t population by way of a therapeutic group setting. Adults were assigned to EFT group treatment for a p eriod of eight weeks. Diagnostic assessment was completed immediately pre and post treatment using the Mini International Neuropsychiatric Interview. In addition to this, self-report assessments measuring symptomatic evidence of depression were completed by the participants before the treatment, after the tr eatment and at three month follow-up. Comparisons with a community group were made at pre and post intervention and three month follow-up. The results indicate d a change in diagnosis in each of the participants, wi th data indicating an overall improvement for the treatment group for depressive symptoms. Study implications and limitations are discussed.

Objectives. To consider whether Youth All Engaged! (a text message intervention) intensified the effects of the adolescent pregnancy prevention Teen Outreach Program (control) for youths. Methods. In this trial performed in Denver, Colorado, from 2011 to 2014, we randomized 8 Boys & Girls Clubs each of 4 years into 32 clubs per year combinations to ensure each club would serve as a treatment site for 2 years and a control site for 2 years. Control intervention consisted of the Teen Outreach Program only. We enrolled 852 youths (aged 14–18 years), and 632 were retained at follow-up, with analytic samples ranging from 50 to 624 across outcomes. We examined program costs, and whether the intervention increased condom and contraceptive use, access to care, and pregnancy prevention. Results. Control program costs were $1184 per participant, and intervention costs were an additional $126 per participant (+10.6%). There were no statistically significant differences in primary outcomes for the full sample. Hispanic participants in the intervention condition had fewer pregnancies at follow-up (1.79%) than did those in the control group (6.72%; P = .02). Conclusions. Youth All Engaged is feasible, low cost, and could have potential benefits for Hispanic youths.

The World Health Organization (WHO) places major depressive disorder (MDD), or depression, as the fourth leading cause of disability worldwide. Some studies have found that cognitive behavioral therapy (CBT) represents the most superior approach in treating mild to severe symptoms. Recent literature has indicated a number of limitations to this therapeutic approach. An approach that has received increasing attention within the literature is the emotional freedom technique (EFT).The current pilot study aimed to evaluate the effectiveness of CBT and EFT in the treatment of depression and comorbid anxiety.The research team designed a pilot study structured as a randomized, controlled trial with 2 intervention arms.The study took place at Bond University in Gold Coast, Queensland, Australia.Participants (n = 10) were local community members who had screened positive for a primary diagnosis of MDD.Participants were randomly assigned to an 8-wk CBT or EFT treatment program, the intervention groups. A sample of individuals from the community was assessed for comparative purposes (control group) (n = 57).Pre- and postintervention, all participants were interviewed using the Mini-International Neuropsychiatric Interview (MINI) 6.0, and they completed the following validated questionnaires: (1) the Beck Depression Inventory, second edition (BDI-2) and (2) the Depression, Anxiety, and Stress Scales (DASS-21).Findings revealed that both treatment approaches produced significant reductions in depressive symptoms, with the CBT group reporting a significant reduction postintervention, which was not maintained with time. The EFT group reported a delayed effect involving a significant reduction in symptoms at the 3- and 6-mo follow-ups only. Examination of the individual cases revealed clinically significant improvements in anxiety across both interventions.Overall, the findings provide evidence to suggest that EFT might be an effective treatment strategy worthy of further investigation.

Background: High rates of sexually transmitted diseases (STDs) present an ongoing costly public health challenge. One approach to reduce STD transmission is to increase the number of clinicians adopting the Centers for Disease Control and Prevention's STD Treatment Guidelines. This evaluation assesses the effectiveness of a 3-day experiential and didactic training to translate recommendations into practice by increasing clinician knowledge and skills and helping participants anticipate and overcome barriers to implementation. Methods: Between 2001 and 2004, 110 direct care clinicians from 10 states participated in one of 27 standardized 3-day interactive trainings offered by the Denver STD/human immunodeficiency virus (HIV) Prevention Training Center. STD/HIV knowledge and clinical skills were measured before, immediately after, and 6 months after training. Practice patterns were assessed before training and after 6 months. Structural barriers to implementation were identified 6 months post-training. Results: Trainees demonstrated significant post-training gains in mean knowledge scores immediately post-training (P < 0.001) and 6 months post-training (P = 0.002). After 6 months, self-reported mean skill levels remained significantly improved compared to precourse (P < 0.05) for each of 27 skills including STD risk assessment, clinical examination, diagnosis, and treatment. Self-reported improvement in practice patterns was significant for 23 of 35 practices (P < 0.05) 6 months post-training. Participants indicated that inadequate time (52.9%), facilities/equipment (51.5%), and staffing (47.1%) interfered with implementation of recommended practices. Conclusions: Experiential―didactic STD/HIV training can modestly improve knowledge, clinical skills, and implementation of STD recommended practices 6 months after training. Further research is needed to identify the impact of improved clinical practices on STD/ HIV transmission.

Purpose: To develop and pilot a theory-based, mobile phone texting component attractive to minority youth as a supplement to the Teen Outreach Program, a youth development program for reducing teen pregnancy and school dropout. Methods: We conducted iterative formative research with minority youth in multiple focus groups to explore interest in texting and reaction to text messages. We piloted a month-long version of TOP Plus Text with 96 teens at four sites and conducted a computer-based survey immediately after enrollment and at the end of the pilot that collected information about teens’ values, social support, self-efficacy, and behaviors relating to school performance, trouble with the law, and sexual activity. After each of the first three weekly sessions we collected satisfaction measures. Upon completion of the pilot we conducted exit interviews with twelve purposively selected pilot participants. Results: We successfully recruited and enrolled minority youth into the pilot. Teens were enthusiastic about text messages complementing TOP . Results also revealed barriers: access to text-capable mobile phones, retention as measured by completion of the post-pilot survey, and a need to be attentive to teen literacy. Conclusions: Piloting helped identify improvements for implementation including offering text messages through multiple platforms so youth without access to a mobile phone could receive messages; rewording texts to allow youth to express opinions without feeling judged; and collecting multiple types of contact information to improve follow-up. Thoughtful attention to social and behavioral theory and investment in iterative formative research with extensive consultation with teens can lead to an engaging texting curriculum that enhances and complements TOP .

BACKGROUND: Sexually transmitted diseases (STDs) and unintended pregnancy are significant and costly public health concerns. Integrating family planning services (FPS) into STD visits provides an opportunity to address both concerns simultaneously. Our objectives were to create an electronic eligibility reminder to identify male and female patients eligible for FPS during an STD clinic visit and measure FPS use additional cost of integrated services and patient/provider satisfaction and to explore the impact on incident pregnancy and STDs. METHODS: Quasi-experimental design compared enrollment and patient/provider satisfaction before (2008) and after implementation (2010). Incident pregnancy and STD 12 months after the initial visit before and after were explored. Time and cost were calculated. Quantitative and qualitative analyses were performed. RESULTS: A total of 9695 clients (male 5842; female 3853) in 2008 and 10021 clients (male 5852; female 4169) in 2010 were eligible for FPS. Enrollment in FPS increased (2008: 51.6% 2010: 95.3%; P < 0.01). Total additional cost was US$29.25/visit and additional staff time was 4.01 minutes for integrated visits. Staff satisfaction increased and client satisfaction remained high. Among women returning within 12 months (39.6% in 2008 37.1% in 2010) pregnancies were lower among enrolled versus nonenrolled women for 2008 (7.7% vs. 19.5% P < 0.01) and 2010 (13.1% vs. 25.9% P = 0.05). Incident STDs did not differ. DISCUSSION: An electronic eligibility reminder of FPS increased FPS use. Integration of FPS with STD services is feasible is well accepted and increases costs minimally. Integration may reduce pregnancy rates without increasing STD rates.