Arik V. Marcell’s research while affiliated with Johns Hopkins Bloomberg School of Public Health and other places

BACKGROUND Male adolescents have significant sexual and reproductive health (SRH) needs and, despite the existence of national guidelines, their SRH care receipt remains poor. Technology-based interventions have been shown to successfully support adolescents’ SRH however no such solutions exist to support comprehensive SRH care delivery for males. OBJECTIVE This paper provides a protocol for the development, user testing, and rigorous evaluation of Health-E You, a web-based mobile application designed to facilitate SRH care delivery for male adolescents. METHODS We will implement a youth-centered design process, using multiple rounds of qualitative data collection and engaging youth and clinician advisors to design the Health-E You app. User testing of the beta version in a clinical setting will inform improvements prior to the launch of a cluster randomized trial with eight primary care settings across the United States that will assess the impact of Health-E You on sexually active male adolescents’ SRH care receipt and condom use. RESULTS Results will consist of qualitative data on male adolescents’ and clinicians’ perspectives on SRH care receipt and delivery, respectively, and their preferences for app design. User testing will provide qualitative and quantitative data on the feasibility, acceptability, and usability of Health-E You in clinical settings. Efficacy trial results will indicate the extent to which the app improves SRH care receipt and condom use among sexually active male adolescents. CONCLUSIONS Findings from this study can be used to inform future technology-based interventions for male adolescents and improve male adolescents’ SRH care receipt in primary care. CLINICALTRIAL NCT06525064

Few studies have examined the pandemic’s impact on both parents-to-be. Our study examined parents’-to-be pandemic-related stress, correlates of pandemic-related stress, and dyadic agreement on pandemic-related stress and its impact. Participants consisted of 74 parent-to-be dyads recruited from a larger text-messaging intervention of fathers-to-be with lower education from February 2020 to February 2022 before their partner was 25 weeks gestation from one mid-Atlantic U.S. city. Our baseline cross-sectional data assessed parents’ pandemic-related stress, perceived pandemic-related impact on infant interactions, help with infant care by caregivers, access to health care, concerns about finances, and participants’ background characteristics. We compared perceived pandemic-related stress and impact within dyads. Separate multivariate linear regressions explored factors associated with pandemic-related stress without and with adjustment for participants’ characteristics stratified by fathers- and mothers-to be. Our findings showed overall low levels of pandemic-related stress, with fathers-to-be within dyads reporting lower levels of pandemic-related stress than reported by mothers-to-be. We found differential factors were associated with greater pandemic-related stress for fathers- than mothers-to-be, except that for both parents greater pandemic-related stress was associated with greater concerns about being able to interact with their own infant and getting infant care help from the mothers’ parents. Whereas greater pandemic-related stress for mothers-to-be was associated with only concerns about getting infant care help, greater stress for fathers-to-be was associated with concerns about getting infant care help and accessing health care. Findings have implications for better understanding expectant parents’ differential response to stressful events that may be informed by gender role expectations during pregnancy and the postpartum period. Clinical Trial Registry and Registration number. Not applicable for the current data presented.

Background: Ensuring patients receive appropriate (CDC-recommended) and prompt ( < 14 days of specimen collection) treatment is critical to decrease gonorrhea and early syphilis (ES) incidence. The objectives were to: 1) quantify treatment performance among community healthcare practices (CHPs); 2) compare CHP treatment performance to local health department goals; and 3) describe variation in treatment performance by CHP characteristics in Baltimore City, Maryland. Methods: Surveillance data for gonorrhea and ES diagnoses reported between January 2018 – December 2019 were used. Treatment performance measures were calculated for each CHP (gonorrhea: 171 CHPs; ES: 122 CHPs). Measures were: 1) percent treated among all diagnoses (goal: > 90%); 2) percent appropriately-treated among diagnoses treated (goal: > 90% gonorrhea, > 95% ES); and 3) percent promptly-treated among diagnoses appropriately-treated (goal: > 85%). Treatment performance measures and achievement of goals were compared across CHP characteristics. Results: For gonorrhea, median percent treated, appropriately-treated, and promptly-treated was 71.4%, 95.0%, and 100.0%, respectively. 29.8% met treated goals. The majority achieved appropriately-treated (62.9%) and promptly-treated (76.8%) goals. CHPs reporting high (vs. low) volume of gonorrhea diagnoses less frequently achieved percent-treated goals (12.2% vs. 35.4%, p = 0.008). Median value for all ES treatment performance measures was 100.0%. Most achieved treated (90.2%) and appropriately-treated (95.9%) goals. 49.2% achieved the promptly-treated goal. CHPs reporting high (vs. low) volumes of ES less frequently achieved promptly-treated goals (33.3% vs. 54.4%, p = 0.045). Conclusions Substantial gaps in reporting gonorrhea treatment and prompt ES treatment were observed. Practice-level interventions to facilitate reporting gonorrhea treatment and provide prompt ES treatment are needed.

This quality improvement initiative aimed to increase first dose of COVID-19 vaccinations during pediatric/adolescent clinic visits. Four plan-do-study-act cycles were performed with creation of eligibility lists and increasing health educator (HE) engagement. Statistical process control analysis assessed vaccine receipt over time. Logistic regression modeling evaluated odds of receipt. Among 6,740 visits, 52.2% of patients were eligible for first COVID-19 vaccine; 17.9% of eligible patients accepted it. First-vaccine improvements from 13.1% to 21.7% were not sustained. Odds of receipt increased in each cycle compared with baseline (1: Odds Ratio=1.99 [95% Confidence Interval 1.49–2.67], 2: OR=2.22 [1.58–3.14]), 3: OR=2.15 [1.51–3.05]), 4: OR=1.48 [1.11–1.96]), and with HE discussion versus no HE discussion (OR=1.64 [1.16–1.90]). First COVID-19 vaccine receipt increased with vaccine-eligible patient lists and HE-initiated discussions, although improvements diminished over time. Health educator versus no HE discussion led to improved vaccinations, supporting further quality improvement research on HE role to improve vaccine uptake.

Purpose: To examine differences in screening and advising for modifiable risk behaviors during well-visits based on adolescents' body mass index categories. Methods: Retrospective analyses were conducted with the National Institute of Health's NEXT Generation Health Study data, a nationally representative cohort of 10th graders. In wave 1 (2010), adolescents were classified as being underweight (<4.99th percentile), normal-weight (5-84.99th percentile), overweight (85-94.99th percentile), or with obesity (≥95th percentile) based on the body mass index categories described by the Centers for Disease Control and Prevention. In wave 2 (2011), adolescents were asked by their provider about smoking, alcohol use, use of other drugs, sexual activity, nutrition, and exercise, and whether they were advised about risks associated with these behaviors. Results: The sample consisted of 1,639 eligible participants as follows: 57.8% females, 63.3% 16-year-olds, 47.8% non-Hispanic Whites, 41.5% living in the South, 75.4% with health insurance, and 29.8% with low family affluence. Screening rates for overweight compared to normal-weight males were 51% reduced for smoking, 46% for alcohol use, 47% for other drug use, 57% for nutrition, and 47% for exercise. Screening rates were 40% reduced for other drug use for males with obesity, and 89% reduced for alcohol use for underweight males compared to normal-weight males. Advice receipt for females with obesity compared to normal-weight females was 90% increased for nutrition and 78% increased for exercise. Discussion: Overweight male adolescents reported being less likely to be screened across almost all preventive service topics representing missed opportunities for care delivery.