Terrence J. Lee-St. John

A New Model for Student Support in High-Poverty Urban Elementary Schools Effects on Elementary and Middle School Academic Outcomes

Efforts to support children in schools require addressing not only academic issues, but also out-of-school factors that can affect students’ ability to succeed. This study examined academic achievement of students participating in City Connects, a student support intervention operating in high-poverty elementary schools. The sample included 7,948 kindergarten to fifth-grade students in a large urban district during 1999–2009. School- and student-level treatment effects on report card grades and standardized test scores in elementary through middle school were estimated. Propensity score methods accounted for pre-intervention group differences. City Connects students demonstrated higher report card scores than comparisons and scored higher on middle school English language arts and mathematics tests. This study provides evidence for the value of addressing out-of-school factors that impact student learning.

Chronicity of partner violence, contraceptive patterns and pregnancy risk

BACKGROUND Partner violence may interfere with a womans ability to maintain continuous contraception and therefore contribute to increased risk of pregnancy among childbearing women. STUDY DESIGN A retrospective review of medical records (N=2000) was conducted from four family planning clinics in the northeast United States. Eligibility criteria for inclusion were as follows: (1) female, (2) reproductive age (menarche through menopause), (3) seeking reproductive services and (4) clinic visit for annual gynecologic exam between 2006 and 2011. RESULTS Partner violence was documented in 28.5% (n=569) of medical records. Chronicity of violence influenced contraceptive patterns and pregnancy risk. Women reporting past year partner violence only [odds ratio (OR)=10.2] and violence during the last 5 years (OR=10.6) had the highest odds of not using a current method of contraception. Women reporting recent exposure to violence were most likely to change birth control methods and use emergency contraception (OR=6.5). Women experiencing any history of violence reported more frequent contraceptive method changes during the previous year. CONCLUSIONS A history of partner violence was common among women utilizing family planning services. The chronicity of violence appeared to play a significant role in contraceptive method changes, types of methods used and pregnancy risk. These results may be one explanation for increased pregnancies among women who experience partner violence.

The Effects of Intimate Partner Violence Duration on Individual and Partner-Related Sexual Risk Factors Among Women

INTRODUCTION Intimate partner violence (IPV) is associated with risk of sexually transmitted infections (STIs) and HIV among women, but less is known about mechanisms of this association and if length of relationship violence is a factor. The purpose of this study was to explore the relationship between the duration of IPV and both individual and partner-related sexual risk factors that may increase womens risk for STIs and HIV. METHODS This was a secondary analysis of data collected from the medical records of 2000 women. Four distinct categories defined the duration of partner violence: violence in the past year only, past year and during the past 5 years, past year plus extending for greater than 5 years, and no past year violence but a history of partner violence. Logistic regression models were used to examine the associations between the duration of partner violence and individual sexual risk behaviors (eg, number of sexual partners, drug and/or alcohol use, anal sex) and partner-related sexual risk factors (eg, nonmonogamy, STI risk, condom nonuse). RESULTS Nearly 30% of the women in the study reported a history of partner violence during their lifetime. All of the individual risk factors, as well as partner-related risk factors, were significantly associated (P < .05) with partner violence and duration of violence. DISCUSSION The study findings extend the knowledge related to partner violence as a risk factor for STIs/HIV, highlighting the effects of partner violence duration on the health of women. Assessing for lifetime experiences of partner violence may improve outcomes for women and their families.

The Association of Health Seeking Behaviors With Human Papillomavirus Vaccination Status Among High-Risk Urban Youth.

Background Vaccination is the primary strategy to reduce the burden of human papillomavirus (HPV) related diseases in the United States. Unvaccinated youth are at risk for HPV infection and associated diseases, and limited research has explored factors associated with HPV vaccination among those who are disadvantaged and at high risk, including lesbian, gay, bisexual, transgender and queer and/or homeless. Methods A retrospective electronic medical record review was conducted at an urban, homeless, and lesbian, gay, bisexual, transgender and queer focused health center in northeastern US logistic regression models examined the associations between HPV vaccination and demographic/social characteristics and health behaviors. Results A total of 1211 men and 1326 women (gender at birth) records were reviewed from patients (ages 13–26 years) who presented for care between January 2010 and June 2013. The sample was diverse, and about half identified as heterosexual and reported stable/secure housing. Approximately 8% of men and 29% of women had obtained ≥ 1 HPV vaccine dose. The strongest predictors of vaccine initiation were health-related behaviors: having an annual examination, obtaining a non-HPV vaccine, and engaging in oral sex. Additionally, for women only, having had a Pap test or a sexually transmitted infection visit were also associated with an increase in odds, whereas identifying as transmale decreased the odds of vaccination. Having private insurance was the only predictor of 3-dose completion (women only). Conclusions Among a high-risk adolescent sample, primarily health-seeking behaviors increased the odds of HPV vaccination, reinforcing the importance of providers using various routine preventative visits as opportunities/cues to vaccine.

Forced sex and sexual consent among college women

ABSTRACT Introduction: Female college students, aged 18–25 years, are at high risk for sexual violence compared with women of other age groups. Lack of clear consent is a preceding and defining component of forced sex and sexual violence. This study explored the association between sexual consent awareness, attitudes, and beliefs and a history of forced sex among a sample of college women. In addition, the level of alcohol use among this group was examined. Methods: A cross-sectional electronic survey was sent to approximately 5900 female students enrolled at a large public university in the northeastern United States. Sexual consent was measured with the Sexual Consent Scale-Revised, and alcohol use was measured with the Alcohol Use Disorders Identification Test-Consumption Items. Logistic regression models were used to examine the differences in sexual consent scores based on a history of forced sex. Results: The final sample included 925 students. Twenty-two percent of participants reported a history of forced sex; more than half (59%) reported alcohol use before sexual activity. Women with greater awareness of sexual consent were significantly more likely to have a history of forced sex. Women who utilize more nonverbal, indirect approaches to communicating sexual consent were significantly less likely to have a history of forced sex compared with women with no history of forced sex. Discussion: These findings highlight high rates of forced sex and alcohol use in a sample of college women and explicate sexual consent awareness and communication behaviors associated with a history of forced sex.

The Long-Term Impact of Systematic Student Support in Elementary School: Reducing High School Dropout.

Dropping out of high school has adverse consequences, including negative effects on employment, lifetime earnings, and physical health. Students often fail to complete high school for complex reasons that often manifest long before they reach high school. This study examines the link between participation in a comprehensive elementary school student support intervention and high school dropout. In this study, students who attended intervention elementary schools in a large, urban, high-poverty district during 2001–2014 (N=894) were compared to students who did not attend intervention schools (N=10,200). Likelihood of dropping out in grades 9–12 was estimated using propensity score-weighted Discrete Event History Analysis. Intervention students had approximately half the odds of dropout (p<.001); the probability of dropout for intervention was 9.2%, compared to 16.6% for non-intervention students. Individually tailored student support interventions during elementary school can lead to lasting and meaningful effects.