The HIV Primary Care Workforce of Tomorrow: The UCSF Integrated HIV/AIDS Primary Care Capacity Nurse Practitioner Program.

The increasing demand for primary care services and the current health care workforce shortage is predicted to cause drastic reductions in the number of clinicians who are competent to provide HIV care. For the past decade, the University of California, San Francisco (UCSF) School of Nursing has provided HIV specialty education for Advanced Practice Nursing students in the Master's curriculum. In 2013, UCSF was funded by the Health Resources Services Administration to establish a nurse practitioner (NP) HIV primary care education program to expand the number of NPs prepared to provide culturally appropriate comprehensive HIV primary care. To this end, UCSF faculty have developed and validated a set of HIV Primary Care entry-level NP competencies, integrated general HIV knowledge into the NP curriculum, and enhanced our current HIV Specialty curriculum and clinical training. Described herein is UCSF's Integrated HIV/AIDS Primary Care Capacity Nurse Practitioner Program.

A school health center intervention for abusive adolescent relationships: a cluster RCT.

BACKGROUND AND OBJECTIVES: Few evidence-based interventions address adolescent relationship abuse in clinical settings. This cluster randomized controlled trial tested the effectiveness of a brief relationship abuse education and counseling intervention in school health centers (SHCs). METHODS: In 2012-2013, 11 SHCs (10 clusters) were randomized to intervention (SHC providers received training to implement) or standard-of-care control condition. Among 1062 eligible students ages 14 to 19 years at 8 SHCs who continued participation after randomization, 1011 completed computer-assisted surveys before a clinic visit; 939 completed surveys 3 months later (93% retention). RESULTS: Intervention versus control adjusted mean differences (95% confidence interval) on changes in primary outcomes were not statistically significant: recognition of abuse = 0.10 (-0.02 to 0.22); intentions to intervene = 0.03 (-0.09 to 0.15); and knowledge of resources = 0.18 (-0.06 to 0.42). Intervention participants had improved recognition of sexual coercion compared with controls (adjusted mean difference = 0.10 [0.01 to 0.18]). In exploratory analyses adjusting for intensity of intervention uptake, intervention effects were significant for increased knowledge of relationship abuse resources and self-efficacy to use harm reduction behaviors. Among participants reporting relationship abuse at baseline, intervention participants were less likely to report such abuse at follow-up (mean risk difference = -0.17 [-0.21 to -0.12]). Adolescents in intervention clinics who reported ever being in an unhealthy relationship were more likely to report disclosing this during the SHC visit (adjusted odds ratio = 2.77 [1.29 to 5.95]). CONCLUSIONS: This is the first evidence of the potential benefit of a SHC intervention to address abusive relationships among adolescents.

Cyber dating abuse among teens using school-based health centers.

OBJECTIVE: To estimate the prevalence of cyber dating abuse among youth aged 14 to 19 years seeking care at school-based health centers and associations with other forms of adolescent relationship abuse (ARA), sexual violence, and reproductive and sexual health indicators. METHODS: A cross-sectional survey was conducted during the 2012-2013 school year (participant n = 1008). Associations between cyber dating abuse and study outcomes were assessed via logistic regression models for clustered survey data. RESULTS: Past 3-month cyber dating abuse was reported by 41.4% of this clinic-based sample. More female than male participants reported cyber dating abuse victimization (44.6% vs 31.0%). Compared with no exposure, low- ("a few times") and high-frequency ("once or twice a month" or more) cyber dating abuse were significantly associated with physical or sexual ARA (low: adjusted odds ratio [aOR] 2.8, 95% confidence interval [CI] 1.8-4.4; high: aOR 5.4, 95% CI 4.0-7.5) and nonpartner sexual assault (low: aOR 2.7, 95% CI 1.3-5.5; high: aOR 4.1, 95% CI 2.8-5.9). Analysis with female participants found an association between cyber dating abuse exposure and contraceptive nonuse (low: aOR 1.8, 95% CI 1.2-2.7; high: aOR 4.1, 95% CI 2.0-8.4) and reproductive coercion (low: aOR 3.0, 95% CI 1.4-6.2; high: aOR 5.7, 95% CI 2.8-11.6). CONCLUSIONS: Cyber dating abuse is common and associated with ARA and sexual assault in an adolescent clinic-based sample. The associations of cyber dating abuse with sexual behavior and pregnancy risk behaviors suggest a need to integrate ARA education and harm reduction counseling into sexual health assessments in clinical settings.

Adolescent substance involvement use and abuse.

Substance use in adolescence is common, but not all use indicates a substance use disorder. The primary care provider has an essential role in screening for substance involvement, assessing the level of substance use and its impact on function, and engaging in a brief intervention to encourage and support behavioral change related to substance use. This article summarizes the literature on adolescent vulnerability to substance use disorders and their impact on adolescent health and well-being. Practical concrete suggestions for approaches to screening, brief interventions, and referral to treatment provide a stepwise approach to adolescent substance use assessment and intervention.

Differences by sexual minority status in relationship abuse and sexual and reproductive health among adolescent females.

PURPOSE: Little is known about adolescent relationship abuse (ARA) and related sexual and reproductive health among females who either identify as lesbian or bisexual or engage in sexual behavior with female partners (i.e., sexual minority girls [SMGs]). METHODS: Baseline data were collected from 564 sexually active girls ages 14-19 years seeking care at eight California school-based health centers participating in a randomized controlled trial. Associations between ARA, sexual minority status and study outcomes (vaginal, oral, and anal sex, number and age of sex partners, contraceptive nonuse, reproductive coercion, sexually transmitted infection [STI] and pregnancy testing) were assessed via logistic regression models for clustered survey data. RESULTS: SMGs comprised 23% (n = 130) of the sample. Controlling for exposure to ARA, SMGs were less likely to report recent vaginal sex (adjusted odds ratio [AOR], .51; 95% confidence interval [CI], .35-.75) and more likely to report recent oral sex (AOR, 2.01; 95% CI, 1.38-2.92) and anal sex (AOR, 1.76; 95% CI, 1.26-2.46) compared with heterosexual girls. Heterosexual girls with ARA exposure (AOR, 2.85; 95% CI, 1.07-7.59) and SMGs without ARA exposure (AOR, 3.01; 95% CI, 2.01-4.50) were more likely than nonabused heterosexual girls be seeking care for STI testing or treatment than heterosexual girls without recent victimization. CONCLUSIONS: Findings suggest the need for attention to STI risk among all girls, but SMGs in particular. Clinicians should be trained to assess youth for sexual contacts and sexual identity and counsel all youth on healthy relationships, consensual sex, and safer sex practices relevant to their sexual experiences.

Health profiles of adolescents in foster care.

The purpose of this paper is to describe health profiles of adolescents in foster care. The Child Health and Illness Profile-Adolescent Edition clustered adolescents in foster care into 13 mutually exclusive health profiles using dimensions of satisfaction with health, risks, resilience, and discomfort. Health profiles were further characterized into four health status rankings from best to worst health status. Many reported best health status (39%); nearly equal numbers (30.6%) had profiles indicating poor or worst health status, particularly girls and those with high risk behaviors, aggression, sexual abuse, or suicidality. It is valuable to identify health characteristics of the most vulnerable subgroups of foster youth to tailor specific interventions.

Adolescent contraception: review and guidance for pediatric clinicians.

The objectives of this article are to review current contraceptive methods available to adolescents and to provide information, guidance, and encouragement to pediatric clinicians to enable them to engage in informed up-to-date interactions with their sexually active adolescent patients. Pregnancy prevention is a complex and dynamic process, and young people benefit from having a reliable authoritative source for information, counseling, and support. Clinicians who provide services for adolescents have a responsibility to develop their skills and knowledge base so that they can serve as that source. This review begins with a discussion about adolescent sexuality and pregnancy in the context of the adolescent developmental stages. We discuss approaches to introduce the topic of contraception during the clinic visit and contraceptive counseling techniques to assist with the discussion around this topic. In addition, information is included regarding confidential services, support of parental involvement, and the importance of male involvement in contraception. The specific contraceptive methods are reviewed in detail with the adolescent patient in mind. For each method, we discuss the mechanism of action, efficacy, contraindications, benefits and risks from the medical perspective, advantages and disadvantages from the patient's perspective, side effects, patient adherence, patient counseling, and any medication interactions. Furthermore, we have included a section that focuses on the contraceptive management for the adolescent patient with a disability and/or chronic illness. The article concludes with an approach to frequently asked or difficult questions. This section largely summarizes subsections on specific contraceptive methods and can be used as a quick reference on particularly challenging topics. Finally, a list of useful contraceptive management resources is provided for both clinicians and patients.

Health risk behavior of youth in foster care.

PROBLEM: Many adolescent health problems are predominantly caused by risk behavior. Foster adolescents have disproportionately poor health; therefore, identification of risk behavior is critical. METHOD: Data from a larger study were analyzed to investigate the health risk behavior of 56 youth in foster care using the Child Health and Illness Profile-Adolescent Edition. FINDINGS: Data indicated that youth in foster care had some increased risk behavior when compared with a normative adolescent population. Younger adolescents and those in relative placement had less risky behavior. Risk behavior was increased for youth in foster care when they were in group homes, had experienced a parental death, or had a history of physical or emotional abuse or attempted suicide. CONCLUSIONS: These results point to areas of strength and vulnerability for youth in foster care and suggest areas for clinicians and caregivers of these adolescents to focus interventions towards harm reduction and enhancement of resiliency.

Enhancing resilience in the adolescent.

Of particular interest to educators, health care, and social service professionals working with young people are those factors upon which we can have an impact as we search for ways to influence and improve the lives of youth with whom we come into contact. In this article the author defines resilience and identifies some of the key theoretical issues related to this concept. Research findings on the characteristics of resilient youth are explored and potential interventions on the individual, program, and policy levels to enhance resilience are presented.