As technologies continue to evolve at exponential rates, online platforms are becoming an increasingly salient social context for adolescents. Adolescents are often early adopters, savvy users, and innovators of technology use. This not only creates new vulnerabilities but also presents new opportunities for positive impact-particularly, the use of technology to promote healthy learning and adaptation during developmental windows of opportunity. For example, early adolescence appears to represent a developmental inflection point in health trajectories and in technology use in ways that may be strategically targeted for prevention and intervention. The field of adolescent health can capitalize on technology use during developmental windows of opportunity to promote well-being and behavior change in the following ways: (1) through a deeper understanding of the specific ways that developmental changes create new opportunities for motivation and engagement with technologies; (2) by leveraging these insights for more effective use of technology in intervention and prevention efforts; and (3) by combining developmental science-informed targeting with broader-reach technologic approaches to health behavior change at the population level (e.g., leveraging and changing social norms). Collaboration across disciplines-including developmental science, medicine, psychology, public health, and computer science-can create compelling innovations to use digital technology to promote health in adolescents.

The transition to young adulthood is accompanied by increased rates of mortality, engagement in risky health behaviors, and chronic conditions. Primary care visits can present a key opportunity for improving the health of young adults through preventive screening and intervention. In this article, we review (1) opportunities for improving young adult preventive health care as a result of the Affordable Care Act (ACA); (2) preventive service guidelines relevant to the young adult age group; (3) a new young adult tool to facilitate the delivery of preventive services; and (4) lessons learned in implementing adolescent guidelines that can inform young adult preventive care. Copyright © 2013 American Academy of Pediatrics. All rights reserved.

Dissemination of HIV behavioral prevention programs has increased the reach of evidence-based interventions, but there is a paucity of data on implementation and diffusion. The present mixed methods study focused on RESPECT, a brief counseling and testing intervention, examining compliance fidelity and the extent to which Centers for Disease Control and Prevention (CDC) policies and training have diffused to practice settings. Using client exit surveys (N = 830) and counselor interviews (N = 64), we examined implementation in 26 community-based agencies (CBOs) and public health departments (DPHs) in the USA. Multivariate analyses showed that at-risk clients, ethnic minority clients, and those who were primarily seeking services other than HIV/STI testing, were more likely to receive the program with fidelity. Counselor data suggested that multiple factors (e.g., client characteristics, agency structure) impact program adaptations. RESPECT is being delivered with good fidelity and reaching at-risk clients. The data provide support for CDC diffusion efforts. Future studies should continue to examine compliance fidelity and program sustainability.

Background

Women aged 50-70 should receive breast, cervical (until age 65), and colorectal cancer (CRC) screening; men aged 50-70 should receive CRC screening and should discuss prostate cancer screening (PSA). PreView, an interactive, individually tailored Video Doctor Plus Provider Alert Intervention, adresses all cancers for which average risk 50-70-year-old individuals are due for screening or screening discussion.

Methods

We conducted a randomized controlled trial in 6 clinical sites. Participants were randomized to PreView or a video about healthy lifestyle. Intervention group participants completed PreView before their appointment and their clinicians received a "Provider Alert." Primary outcomes were receipt of mammography, Pap tests (with or without HPV testing), CRC screening (FIT in last year or colonoscopy in last 10 years), and PSA screening discussion. Additional outcomes included breast, cervical, and CRC screening discussion.

Results

A total of 508 individuals participated, 257 in the control group and 251 in the intervention group. Screening rates were relatively high at baseline. Compared with baseline screening rates, there was no significant increase in mammography or Pap smear screening, and a nonsignificant increase (18% vs 12%) in CRC screening. Intervention participants reported a higher rate of PSA discussion than did control participants (58% vs 36%: P < 0.01). Similar increases were seen in discussions about mammography, cervical cancer, and CRC screening.

Conclusion

In clinics with relatively high overall screening rates at baseline, PreView did not result in significant increases in breast, cervical, or CRC screening. PreView led to an increase in PSA screening discussion. Clinician-patient discussion of all cancer screenings significantly increased, suggesting that interventions like PreView may be most useful when discussion of the pros and cons of screening is recommended and/or with patients reluctant to undergo screening. Future research should investigate PreView's impact on those who are hesitant or reluctant to undergo screening.

Trial registration

ClinicalTrials.gov: NCT02264782.

Although many trials of cancer screening interventions evaluate efficacy and effectiveness, less research focuses on how to sustain interventions in non-research settings, which limit the potential reach of these interventions. Identifying the factors that influence the potential for sustainability is critical. We evaluate the factors influencing sustainability of PreView, a Cancer Screening Intervention, within the context of the Practical, Robust Implementation and Sustainability Model (PRISM). PRISM includes organizational and patient perspectives of the intervention as well as characteristics of the organizational and patient recipients. It considers how the program or intervention design, external environment, implementation, and sustainability infrastructure and the recipients influence program adoption, implementation, and maintenance. We evaluate the attempts at sustainability of PreView within the constructs of PRISM. Encouraging patients to use PreView was more difficult outside of a clinical trial. Organizational perspectives on how the intervention fit in with other goals, patient perspectives on how the intervention is individualized (i.e. being able to choose which cancer screening to address) and focused on barriers, patient characteristics (i.e. having multiple comorbidities making cancer screening less of a priority), organizational characteristics (i.e. middle managers having competing responsibilities), external environment influences (i.e. reimbursement for achieving certain cancer screening goals), and sustainability infrastructure all affect the likelihood of PreView being sustained in clinical practice. Despite advance planning for sustainability, adapting interventions to achieve sustainability is difficult. Lessons learned from evaluating PreView within the PRISM model can inform future sustainability efforts.

BACKGROUND: Women aged 50-70 should receive breast, cervical (until age 65), and colorectal cancer (CRC) screening; men aged 50-70 should receive CRC screening and should discuss prostate cancer screening (PSA). PreView, an interactive, individually tailored Video Doctor Plus Provider Alert Intervention, adresses all cancers for which average risk 50-70-year-old individuals are due for screening or screening discussion. METHODS: We conducted a randomized controlled trial in 6 clinical sites. Participants were randomized to PreView or a video about healthy lifestyle. Intervention group participants completed PreView before their appointment and their clinicians received a Provider Alert. Primary outcomes were receipt of mammography, Pap tests (with or without HPV testing), CRC screening (FIT in last year or colonoscopy in last 10 years), and PSA screening discussion. Additional outcomes included breast, cervical, and CRC screening discussion. RESULTS: A total of 508 individuals participated, 257 in the control group and 251 in the intervention group. Screening rates were relatively high at baseline. Compared with baseline screening rates, there was no significant increase in mammography or Pap smear screening, and a nonsignificant increase (18% vs 12%) in CRC screening. Intervention participants reported a higher rate of PSA discussion than did control participants (58% vs 36%: P < 0.01). Similar increases were seen in discussions about mammography, cervical cancer, and CRC screening. CONCLUSION: In clinics with relatively high overall screening rates at baseline, PreView did not result in significant increases in breast, cervical, or CRC screening. PreView led to an increase in PSA screening discussion. Clinician-patient discussion of all cancer screenings significantly increased, suggesting that interventions like PreView may be most useful when discussion of the pros and cons of screening is recommended and/or with patients reluctant to undergo screening. Future research should investigate PreViews impact on those who are hesitant or reluctant to undergo screening. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02264782.

Introduction

While pediatricians should receive training in the care of transgender youth, a paucity of formal educational curricula have been developed to train learners to care for this vulnerable population.

Methods

We developed a curriculum including six online modules and an in-person afternoon session observing clinic visits in a pediatric gender clinic. Learners-fourth-year medical students, interns, and nurse practitioner trainees-received protected time during an adolescent medicine rotation to complete the online modules (total duration: 77 minutes). For 20 learners, we assessed the impact of the entire curriculum-online modules and in-person observation-on self-perceived knowledge of considerations for transgender youth. For 31 learners, we assessed the effect of the online modules alone on knowledge and self-efficacy. Descriptive analyses illustrated changes in educational domains by learner group.

Results

On evaluations of the entire curriculum (modules and observation), median self-perceived knowledge scores (1 = not at all knowledgeable/aware, 5 = extremely knowledgeable/aware) increased within learner groups: pediatric interns (from 2.3 to 4.0), nurse practitioner trainees (from 2.9 to 4.7), fourth-year medical students (from 3.3 to 4.9), and psychiatry interns (from 2.8 to 4.4). Assessment of learners completing only the online modules demonstrated increases in median knowledge and self-efficacy scores within learner groups. All learner groups highly valued the curriculum.

Discussion

Our curriculum for multidisciplinary learners in the care of transgender youth was successful and well received. Increasing learner knowledge and self-efficacy is an important step towards skill development in patient care for the transgender youth population.

INTRODUCTION: While pediatricians should receive training in the care of transgender youth, a paucity of formal educational curricula have been developed to train learners to care for this vulnerable population. METHODS: We developed a curriculum including six online modules and an in-person afternoon session observing clinic visits in a pediatric gender clinic. Learners-fourth-year medical students, interns, and nurse practitioner trainees-received protected time during an adolescent medicine rotation to complete the online modules (total duration: 77 minutes). For 20 learners, we assessed the impact of the entire curriculum-online modules and in-person observation-on self-perceived knowledge of considerations for transgender youth. For 31 learners, we assessed the effect of the online modules alone on knowledge and self-efficacy. Descriptive analyses illustrated changes in educational domains by learner group. RESULTS: On evaluations of the entire curriculum (modules and observation), median self-perceived knowledge scores (1 = not at all knowledgeable/aware, 5 = extremely knowledgeable/aware) increased within learner groups: pediatric interns (from 2.3 to 4.0), nurse practitioner trainees (from 2.9 to 4.7), fourth-year medical students (from 3.3 to 4.9), and psychiatry interns (from 2.8 to 4.4). Assessment of learners completing only the online modules demonstrated increases in median knowledge and self-efficacy scores within learner groups. All learner groups highly valued the curriculum. DISCUSSION: Our curriculum for multidisciplinary learners in the care of transgender youth was successful and well received. Increasing learner knowledge and self-efficacy is an important step towards skill development in patient care for the transgender youth population.

Purpose

To examine self-reported rates and disparities in delivery of preventive services to young adults.

Methods

A population-based cross-sectional analysis, of 3,670 and 3,621 young adults aged 18-26 years who responded to California Health Interview Survey (CHIS) in 2005 and CHIS 2007, respectively. The main outcome measures were self-reported receipt of flu vaccination, sexually transmitted disease (STD) screening, cholesterol screening, diet counseling, exercise counseling, and emotional health screening. Multivariate logistic regression was used to examine how age, gender, race/ethnicity, income, insurance, and usual source of care influence the receipt of preventive services.

Results

Delivery rates ranged from 16.7% (flu vaccine) to 50.6% (cholesterol screening). Being female and having a usual source of care significantly increased receipt of services, with female participants more likely to receive STD screening (p < .001), cholesterol screening (p < .01), emotional health screening (p < .001), diet counseling (p < .01), and exercise counseling (p < .05) than male participants after controlling for age, race/ethnicity, income, insurance, and usual source of care. Young adults with a usual source of care were more likely to receive a flu vaccine (p < .05), STD screening (p < .01), cholesterol screening (p < .001), diet counseling (p < .05), and exercise counseling (p < .05) than those without a usual source of care after adjusting for age, race/ethnicity, income, and insurance.

Conclusions

Rates of preventive services delivery are generally low. Greater efforts are needed to develop guidelines for young adults to increase the delivery of preventive care to this age-group, and to address the gender and ethnic/racial disparities in preventive services delivery.