Teresa M. Imburgia

Predictors of influenza vaccination in the U.S. among children 9–13 years of age

BACKGROUND AND OBJECTIVES U.S. estimates of seasonal influenza (flu) vaccine uptake in 2014-2015 were 62% for 5-12year olds, dropping to 47% for 13-17year olds. The Healthy People 2020 goal for these age groups is 80%. It is important to understand factors associated with influenza vaccination, especially for those ages where rates begin to decline. The objective of this study was to identify factors associated with influenza vaccination acceptance in 9-13year old children. METHODS An online U.S. survey of mothers of children aged 9-13 assessed childrens influenza vaccine uptake in the previous season, healthcare utilization, sociodemographics, and vaccine attitudes. Multivariable logistic regression identified independent predictors of influenza vaccine status. RESULTS There were 2363 respondents (Mean age=38years old). Referent children were 57% female and 66% non-minority race/ethnicity with a mean age of 10.6years. By maternal report, 59% of children had received an influenza vaccine in the previous season. Predictors of influenza vaccine uptake included a recommendation or strong recommendation from a health care provider, seeing a health care provider in the past year, positive attitudes regarding the influenza vaccine, and being a minority race. Child gender, age, insurance coverage, and whether the child had a regular healthcare provider were not associated with influenza vaccine uptake (p=n.s.). CONCLUSIONS This sample reported overall rates of influenza vaccine uptake similar to national surveillance data, but still lower than national goals. Provider recommendations along with health attitudes and seeing a health care provider were associated with vaccine uptake. Promising interventions may include more directive physician messaging for influenza vaccine uptake in youth, encouraging more regular well-child visits during the adolescent years, and promoting influenza vaccination at alternative sites.

Utilization of Concrete Services in Child Welfare: A Mixed Method Analysis of a Title IV-E Waiver Demonstration Program

ABSTRACT Concrete services are goods and services, such as rent, utilities, healthcare, or other tangible services, that are purchased directly by child welfare agencies to help support the short-term needs of a family. Practice wisdom in social work details the importance of meeting basic needs in order for clients to be able to concentrate on completing the case plan. Some literature has mentioned the importance of concrete services for child welfare practice. However, research has been limited about utilization of these services and their impact on child welfare outcomes. The current mixed methods study examines expenditures for concrete services across four categories over a four-year period in one Midwestern state. The justifications for caseworker concrete service requests and the perceptions of regional and executive managers regarding the effectiveness of the use of concrete services are also examined. Descriptive analysis revealed distributions varied by age and concrete service type. Both caseworker justifications and regional manager interviews revealed the same general themes for children: support of child safety, permanency, and well-being are supported with the use of concrete services.

Redetection of human papillomavirus type 16 infections of the cervix in mid-adult life

Purpose To assess whether HPV 16 originally detected in adolescent women can be redetected in adulthood. Methods A convenience sample of 27 adult women with known HPV 16 detection during adolescence was assessed for HPV 16 redetection. A comparison of the long control region (LCR) DNA sequences was performed on some of the original and redetected HPV 16 isolates. Results Median age at reenrollment was 27.5 years (interquartile range of 26.7–29.6). Reenrollment occurred six years on average after the original HPV 16 detection. Eleven of 27 women had HPV 16 redetected. Some of these HPV 16 infections had apparently cleared during adolescence. LCR sequencing was successful in paired isolates from 6 women; in 5 of 6 cases the redetected HPV 16 isolates were identical to those detected during adolescence, Conclusions HPV 16 may be episodically detected in young women, even over long time periods. HPV 16 redetection with identical LCR sequences suggests low-level persistent infection rather than true clearance, although newly acquired infection with an identical HPV 16 isolate cannot be excluded. However, this study suggests that a new HPV 16-positive test in a clinical setting may not indicate a new infection.

Studying process in a Title IV-E waiver evaluation project: Interviews with regional and executive managers

ABSTRACT A Midwestern state’s child welfare agency contracted with a university to evaluate a 5-year Title IV-E Waiver Demonstration Project. As part of the process study, evaluators employed case study analysis to investigate Waiver knowledge and effects as reported by Regional and Executive Managers across 4 years of the demonstration period. Data from 78 interviews reveal enhanced levels of manager–evaluator rapport and integrated Waiver knowledge across years of data collection. This study highlights the value of middle managers as rich data sources, studying process through qualitative methods in child welfare evaluation, and how consistent relationships can support partnerships over time.

Community Engagement and Venue-Based Sampling in Adolescent Male Sexually Transmitted Infection Prevention Research

OBJECTIVES Middle adolescent males are a difficult group to recruit for community sexually transmitted infection (STI) prevention research. We describe a process of community engagement, and venue-based sampling of 14-17-year-old adolescent males, and compare rates of STIs and STI risk behaviors by venue. METHODS Community engagement consisted of (1) informational meetings with organizations; (2) participation in community meetings and events; (3) hiring community members as study personnel; and (4) an adolescent advisory board recruited from the community. Venues were identified and assessed at different times of the day and days of the week using a structured tool. At selected venues, males ages 14-17 years were invited to participate in a brief survey and provide a urine sample and an optional anal swab for DNA-based STI testing. RESULTS Venues were assessed (n = 249), and 31 were selected for recruitment, including parks, apartment complexes, community events, entertainment venues, a community school, and community programs for LGBT (gay, lesbian, bisexual, transgender) and adjudicated youth. We enrolled 667 participants, average age 15.7 years. Participants reported high rates of sexual and STI risk behaviors, but had low rates of STIs. These rates differed by venue, with more structured venues recruiting youth reporting fewer STI risk behaviors and less structured venues within the highest STI prevalence zip code recruiting youth reporting more STI risk behaviors. CONCLUSION Venue-based sampling is a feasible mechanism to target recruitment and enrollment adolescent males with high STI risk behaviors in community settings, with risk profiles varying by setting.

Women's understanding of their Pap and HPV test results: Implications for patient–provider communication

ABSTRACT Background: As changing guidelines for cervical cancer detection incorporate more human papillomavirus (HPV) testing along with Papanicolaou (Pap) smear testing (‘co-testing’) in clinical practice, there is a need to evaluate patient understanding of these two tests. Methods: Thirty women (mean age = 27.8 years; 90% African-American) with low SEC status were recruited for two clinical research visits; a Pap test and cervical HPV test were performed at the first visit and a doctor shared the test results (i.e. Pap and HPV test) at the second. Then, a semi-structured interview focused on participants’ recall of the discussion with the provider as well as their general understanding of the tests. Results: Findings revealed participants were familiar with the Pap test and were proactive about receiving the test, despite lacking accurate knowledge about the purpose of the test. On the other hand, when participants expressed confusion and anxiety about the HPV test, patient–provider communication helped to ease some of these concerns. Patients expressed a range of ability in reconciling how the two tests were connected, what the two results meant together, and why both are needed. Conclusion: This qualitative data suggests important gaps in womens understandings of Pap test and HPV test results, especially when used together in a clinical visit. There is a need to address this lack of understanding as the use of co-testing in clinical practice increases. Implications for improved communication strategies between patients and providers about how to share and interpret Pap test and HPV tests results in the clinical setting are discussed.