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Introduction The Perinatal Periods of Risk approach (PPOR) is designed for use by communities to assess and address the causes of high fetal-infant mortality rates using vital records data. The approach is widely used by local health departments and their community and academic partners to inform and motivate systems changes. PPOR was developed and tested in communities based on data years from 1995 to 2002. Unfortunately, a national reference group has not been published since then, primarily due to fetal death data quality limitations. Methods This paper assesses data quality and creates a set of unbiased national reference groups using 2014-2016 national vital records data. Phase 1 and Phase 2 analytic methods were used to divide excess mortality into six components and create percentile plots to summarize the distribution of 100 large US counties for each component. Results Eight states with poor fetal death data quality were omitted from the reference groups to reduce bias due to missing maternal demographic information. There are large Black-White disparities among reference groups with the same age and education restrictions, and these vary by component. PPOR results vary by region, maternal demographics, and county. The magnitude of excess mortality components varies widely across US counties. Discussion New national reference groups will allow more communities to do PPOR. Percentile plots of 100 large US counties provide an additional benchmark for new communities using PPOR and help emphasize problem areas and potential solutions., Author(s): Carol S. Gilbert [sup.1] , Pamela K. Xaverius [sup.2] [sup.5] , Melissa K. Tibbits [sup.3] , William M. Sappenfield [sup.4] Author Affiliations: (1) grid.266813.8, 0000 0001 0666 4105, CityMatCH [...]

Sex education both in and beyond the classroom has been shown to have the potential to ameliorate negative sexual health outcomes for adolescents. School-based sex education and sexual health services targeting young people should be informed, in part, by teenagers themselves. Semi-structured interviews were conducted with 41 young people aged 13-22 years in a mid-sized midwest US city to inform such programme development. Analysis employed both top-down and bottom-up approaches to coding. Four themes emerged regarding sex education activities in and out of school: the need for knowledge of current activities aimed at prevention; information-seeking behaviours; personal views on how to address teenage pregnancy and sexually transmitted infections (STIs); and the ideal place to address these issues. Current activities were seen as ineffective or non-existent. Many participants indicated they would not engage actively in information-seeking unless they were affected personally by the issues. Participants' suggestions of how to address the issues included improving school services, introducing media campaigns and having peer or trusted-adult educators. Participants identified the need for services that offered confidentiality, a non-judgemental approach and a comfortable space to meet. Through direct engagement with youth, this research makes recommendations for interventions to address teenage pregnancy and STIs.

School-based health centers (SBHCs) have been suggested as potential medical homes, yet minimal attention has been paid to measuring their patient-centered medical home (PCMH) implementation. The purposes of this article were to (1) develop an index to measure PCMH attributes in SBHCs, (2) use the SBHC PCMH Index to compare PCMH capacity between PCMH certified and non-PCMH SBHCs, and (3) examine differences in index scores between SBHCs based in schools with and without adolescents. A total of six PCMH dimensions in the SBHC PCMH Index were identified through factor analysis. These dimensions were collapsed into two domains: care quality and comprehensive care. SBHCs recognized as PCMHs had higher scores on the index, both domains, and four dimensions. SBHCs based in schools with just young children and those with adolescents scored similarly on the overall index, but analysis of individual index items shows their strengths and weaknesses in PCMH implementation.

Purpose Although adolescence is a critical developmental period, there has not been coordinated effort to comprehensively address adolescent health within the field of maternal and child health (MCH). In order to inform future adolescent health efforts, MCH leaders in local health departments were asked to reflect on the greatest health challenges facing adolescents in their communities, the causes of these health challenges, the interventions currently implemented to promote adolescent health, and additional intervention needs. Description 15 interviews were conducted in 2018 with 13 city and county health departments and two community-based agencies (N = 19). Interviews were recorded and transcribed verbatim. Mutually agreed upon themes were determined by the research team and these themes were used to code the transcripts. Results Mental and behavioral health and sexual and reproductive health issues were perceived to be the greatest health challenges facing adolescents. Participants attributed these health issues to the social determinants of health and adverse childhood experiences. Although all health departments offered sexual and reproductive health interventions, few implemented mental and behavioral health interventions. Insufficient funding and collaboration challenges were the major barriers impeding the implementation of additional coordinated adolescent health interventions. Conclusion Coordinated funding and technical assistance will be needed to enable MCH professionals in local health to realize their potential to improve the health of adolescents. Specific observations and opportunities were addressed in efforts to create conversation that would lead to an improvement in adolescent health services within local health departments, as well as communities and the field of MCH., Author(s): Melissa Tibbits [sup.1] , Kiara Lyons [sup.2] , Chad Abresch [sup.2] Author Affiliations: (1) grid.266813.8, 0000 0001 0666 4105, Department of Health Promotion, University of Nebraska Medical Center, , [...]

A growing body of research suggests that acculturation may play a role in the disproportionate likelihood of sexual risk behaviour and STI/HIV infection among Hispanic youth in the USA. We systematically reviewed the relationship between acculturation and STI/HIV-related sexual risk behaviour among Hispanic youth aged 13–24 by reviewing studies that have used a bidimensional acculturation approach. Electronic databases were searched with the searches limited to articles published in 1992 when the concept of bidimensional acculturation was introduced or later. Two independent researchers screened the full data set to assess eligibility. Six studies were included. Three studies used cross-sectional data, while the other three used longitudinal data. We discovered that sexual risk behaviours differed by Hispanic youth acculturation types and were moderated by gender. We found that Hispanic acculturated youth had lower odds of having multiple sex partners than US acculturated youth. However, the relationship between acculturation and condom use yielded contradictory results and we could find no report on bi-culturation and sexual behaviour. Additional research is needed to explore whether adopting both US and Hispanic-heritage cultures at the same time may reduce or increase the odds of engaging in sexual risk behaviour among Hispanic youth in the USA. [ABSTRACT FROM AUTHOR]

This study was designed to evaluate the efficacy of the HealthWise South Africa HIV and substance abuse prevention program at impacting adolescents' polydrug use and sexual risk behaviors. HealthWise is a school-based intervention designed to promote social-emotional skills, increase knowledge and refusal skills relevant to substance use and sexual behaviors, and encourage healthy free time activities. Four intervention schools in one township near Cape Town, South Africa were matched to five comparison schools (N = 4040). The sample included equal numbers of male and female participants (Mean age = 14.0). Multiple regression was used to assess the impact of HealthWise on the outcomes of interest. Findings suggest that among virgins at baseline (beginning of eighth grade) who had sex by Wave 5 (beginning of 10th grade), HealthWise youth were less likely than comparison youth to engage in two or more risk behaviors at last sex. Additionally, HealthWise was effective at slowing the onset of frequent polydrug use among non-users at baseline and slowing the increase in this outcome among all participants. Program effects were not found for lifetime sexual activity, condomless sex refusal and past-month polydrug use. These findings suggest that HealthWise is a promising approach to HIV and substance abuse prevention.

This mixed methods study sought to build knowledge of inclusivity practices among 10 CI initiatives. Analyses across two strands of research revealed two distinct definitions of inclusivity: broad inclusivity, which seeks the participation of everyone; and, representative inclusivity, which seeks individuals affected by the problems being addressed. While several of the initiatives had improved inclusivity practices since adopting CI, only a few were found to be broadly inclusive and most acknowledged operating in intentionally exclusive ways at times. All of the initiatives valued representative inclusivity, but members reported struggling to achieve even minimal levels. Proponents of CI should continue to develop guides for practitioners to help ensure both forms of inclusivity. [ABSTRACT FROM AUTHOR]

The goal of this study was to assess the utility of participatory needs assessment processes for continuous improvement of developing clinical and translational research (CTR) networks. Our approach expanded on evaluation strategies for CTR networks, centers, and institutes, which often survey stakeholders to identify infrastructure or resource needs, using the case example of the Great Plains IDeA-CTR Network. Our 4-stage approach (i.e., pre-assessment, data collection, implementation of needs assessment derived actions, monitoring of action plan) included a member survey (n = 357) and five subsequent small group sessions (n = 75 participants) to better characterize needs identified in the survey and to provide actionable recommendations. This participatory, mixed-methods needs assessment and strategic action planning process yielded 11 inter-related recommendations. These recommendations were presented to the CTR steering committee as inputs to develop detailed, prioritized action plans. Preliminary evaluation shows progress towards improved program capacity and effectiveness of the network to respond to member needs. The participatory, mixed-methods needs assessment and strategic planning process allowed a wide range of stakeholders to contribute to the development of actionable recommendations for network improvement, in line with the principles of team science. [ABSTRACT FROM AUTHOR]