Adolescents with involvement in the correctional system have significant health risks and needs. Professional guidelines and policies related to health services in correctional settings can help health care providers who work in youth detention facilities and those who see youth for follow-up care after incarceration. Several challenges exist to providing care in detention facilities, but overcoming these barriers to optimally serve youth is critical. When youth are released to their homes, community providers must understand the extent of care offered in detention facilities, the unique considerations for youth on probation, and the aspects of follow-up care that should be addressed.

Developmental transitions are experienced throughout the life course and necessitate adapting to consequential and unpredictable changes that can undermine health. Our six-month study (n = 239) explored whether selective secondary control striving (motivation-focused thinking) protects against the elevated levels of stress and depressive symptoms increasingly common to young adults navigating the challenging school-to-university transition. Path analyses supplemented with tests of moderated mediation revealed that, for young adults who face challenging obstacles to goal attainment, selective secondary control indirectly reduced long-term stress-related physical and depressive symptoms through selective primary control and previously unexamined measures of discrete emotions. Results advance the existing literature by demonstrating that (a) selective secondary control has health benefits for vulnerable young adults and (b) these benefits are largely a consequence of the process variables proposed in Heckhausen et al.'s (2010) theory.

With 2.3 million individuals incarcerated in the United States, incarceration remains a pressing social influence on health. While risk factors for incarceration are known, research has been slow to identify protective factors. Characterizing adolescent protective and risk factors for incarceration outcomes can inform interventions to prevent incarceration. Using survey data from the National Longitudinal Study of Adolescent to Adult Health, we tested the influence of adolescent risk and protective factors for incarceration of young people. We used ordinal logistic regressions, investigating the relationship between adolescent characteristics (wave I, grades 7–12) with two outcomes: incarceration onset (no incarceration, onset of incarceration as a juvenile, and onset of incarceration as an adult) and incarceration frequency (never incarcerated, incarcerated once, incarcerated more than once) during adolescence and into adulthood (N = 12,136, wave IV, ages 24–32). Adolescent protective factors against incarceration onset and higher incarceration frequency centered on education, including a higher grade point average and a higher likelihood of having future plans to attend college. Risk factors included disruptive behavior, physical or sexual abuse in childhood, parental incarceration, and living with a stepfather figure. Stratified analyses suggested that Latinos may have unique risk profiles compared to African American and White youth. The educational system may be a locus for protective interventions promoting academic achievement and educational aspirations. Understanding both incarceration risk and protective factors may allow interventions to be tailored appropriately.

Background

Urogenital Chlamydia trachomatis infection remains prevalent and causes substantial reproductive morbidity. Recent studies have raised concern about the efficacy of azithromycin for the treatment of chlamydia infection.

Methods

We conducted a randomized trial comparing oral azithromycin with doxycycline for the treatment of urogenital chlamydia infection among adolescents in youth correctional facilities, to evaluate the noninferiority of azithromycin (1 g in one dose) to doxycycline (100 mg twice daily for 7 days). The treatment was directly observed. The primary end point was treatment failure at 28 days after treatment initiation, with treatment failure determined on the basis of nucleic acid amplification testing, sexual history, and outer membrane protein A (OmpA) genotyping of C. trachomatis strains.

Results

Among the 567 participants enrolled, 284 were randomly assigned to receive azithromycin, and 283 were randomly assigned to receive doxycycline. A total of 155 participants in each treatment group (65% male) made up the per-protocol population. There were no treatment failures in the doxycycline group. In the azithromycin group, treatment failure occurred in 5 participants (3.2%; 95% confidence interval, 0.4 to 7.4%). The observed difference in failure rates between the treatment groups was 3.2 percentage points, with an upper boundary of the 90% confidence interval of 5.9 percentage points, which exceeded the prespecified absolute 5-percentage-point cutoff for establishing the noninferiority of azithromycin.

Conclusions

In the context of a closed population receiving directly observed treatment for urogenital chlamydia infection, the efficacy of azithromycin was 97%, and the efficacy of doxycycline was 100%. The noninferiority of azithromycin was not established in this setting. (Funded by the National Institute of Allergy and Infectious Diseases; ClinicalTrials.gov number, NCT00980148.).

PURPOSE: To understand clinician and clinical staff perspectives on the implementation of routine Adverse Childhood Experience (ACE) screening in pediatric primary care. METHODS: We conducted a qualitative evaluation in 5 clinics in Los Angeles County, California, using 2 rounds of focus group discussions: during an early phase of the initiative, and 7 months later. In the first round, we conducted 14 focus group discussions with 67 participants. In the second round, we conducted 12 focus group discussions with 58 participants. Participants comprised clinic staff involved in ACE screening, including frontline staff that administer the screening, medical clinicians that use screening to counsel patients and make referrals, and psychosocial support staff who may receive referrals. RESULTS: Themes were grouped into 3 categories: (1) screening acceptability and perceived utility, (2) implementation and quality improvement, and (3) effects of screening on patients and clinicians. Regarding screening acceptability and perceived utility, clinicians generally considered ACE screening to be acceptable and useful. In terms of implementation and quality improvement, significant barriers included: insufficient time for screening and response, insufficient training, and lack of clarity about referral networks and resources that could be offered to patients. Lastly, regarding effects of screening, clinicians expressed that ACE screening helped elicit important patient information and build trust with patients. Further, no adverse events were reported from screening. CONCLUSIONS: Clinic staff felt ACE screening was feasible, acceptable, and beneficial within pediatric care settings to improve trauma-informed care and that ACE screening could be strengthened by addressing time constraints and limited referral resources.