Reflections from Refugee Adolescent Girls on Participation in a US-Based Teen Sexual Health Promotion Project.

Refugee girls may be unprepared for the sexual risk challenges facing teens in the US. We sought to understand refugee girls' general experience, discussions with parents and motivations related to participation in an evidence-based sexual risk reduction program. Through semi-structured interviews with twelve girls ages 15-17 years from nine countries, we acquired insight into the girls' reactions to the program, if they had discussed their experiences, and reflections on their decision to participate. Qualitative analysis of verbatim transcriptions identified three themes: (1) my cultural norm is not to ask; (2) groups were a safe way for me to learn and share; and (3) I learned to use my voice. As the numbers of adolescent refugees grow, we cannot ignore their need for tailored sexual health research and programming. This first-of-its-kind study provides insight into acceptability, motivation for participation, and impact of a sexual health promotion program.

Sexual and reproductive health information and referrals for resettled refugee women: A survey of resettlement agencies in the United States.

BACKGROUND: Refugee resettlement offices are the first point of contact for newly arrived refugees and play a significant role in helping refugees acclimate and settle into life in the United States. Available literature suggests that refugee women are vulnerable to poor sexual and reproductive health (SRH) outcomes, including sexually transmitted infections and HIV infections as well as adverse pregnancy outcomes, but little is known about the role that refugee resettlement offices play in supporting refugee women's SRH. This study examines the capacity and interest of resettlement offices in providing SRH information and referrals to newly arrived refugees. METHODS AND FINDINGS: The research team conducted an online survey of staff members at refugee resettlement offices throughout the US in 2018 to determine (1) available SRH resources and workshops; (2) referrals to and assistance with making appointments for SRH and primary care appointments; (3) barriers to addressing SRH needs of clients; and (4) interest in building the capacity of office staff to address SRH issues. The survey was created for this study and had not been previously used or validated. Survey data underwent descriptive analysis. A total of 236 resettlement offices were contacted, with responses from 100 offices, for a total response rate of 42%. Fifteen percent (N = 15) of refugee resettlement agencies (RRAs) who responded to the survey provide materials about SRH to clients, and 49% (N = 49) incorporate sexual health into the classes they provide to newly arrived refugee clients. Moreover, 12% (N = 12) of responding RRAs screen clients for pregnancy intention, and 20% (N = 20) directly refer to contraceptive care and services. This study is limited by the response rate of the survey; no conclusions can be drawn about those offices that did not respond. In addition, the survey instrument was not validated against any other sources of information about the practices of refugee resettlement offices. CONCLUSIONS: In this study, we observed that many resettlement offices do not routinely provide information or referrals for SRH needs. Responding offices cite lack of time and competing priorities as major barriers to providing SRH education and referrals to clients.

"Where Is the Women's Center Here?": The Role of Information in Refugee Women's Help Seeking for Intimate Partner Violence in a Resettlement Context.

A qualitative study examined factors that hinder help seeking for intimate partner violence among women who resettled to the United States as refugees. A refugee resettlement agency recruited female clients (n = 35) and service providers and stakeholders (n = 53) in the metropolitan area. The study employed individual interviews and focus group discussions to collect data. An inductive and interpretive thematic approach guided the analytical process. The analysis revealed challenges related to information gaps and communication struggles complicating help-seeking processes. The findings point to the importance of bolstering information sharing within and across informal and formal networks to help women navigate support and services in resettlement.

REPRINT OF: Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study.

BACKGROUND: The relationship of health risk behavior and disease in adulthood to the breadth of exposure to childhood emotional, physical, or sexual abuse, and household dysfunction during childhood has not previously been described. METHODS: A questionnaire about adverse childhood experiences was mailed to 13,494 adults who had completed a standardized medical evaluation at a large HMO; 9,508 (70.5%) responded. Seven categories of adverse childhood experiences were studied: psychological, physical, or sexual abuse; violence against mother; or living with household members who were substance abusers, mentally ill or suicidal, or ever imprisoned. The number of categories of these adverse childhood experiences was then compared to measures of adult risk behavior, health status, and disease. Logistic regression was used to adjust for effects of demographic factors on the association between the cumulative number of categories of childhood exposures (range: 0-7) and risk factors for the leading causes of death in adult life. RESULTS: More than half of respondents reported at least one, and one-fourth reported ≥2 categories of childhood exposures. We found a graded relationship between the number of categories of childhood exposure and each of the adult health risk behaviors and diseases that were studied (P < .001). Persons who had experienced four or more categories of childhood exposure, compared to those who had experienced none, had 4- to 12-fold increased health risks for alcoholism, drug abuse, depression, and suicide attempt; a 2- to 4-fold increase in smoking, poor self-rated health, ≥50 sexual intercourse partners, and sexually transmitted disease; and a 1.4- to 1.6-fold increase in physical inactivity and severe obesity. The number of categories of adverse childhood exposures showed a graded relationship to the presence of adult diseases including ischemic heart disease, cancer, chronic lung disease, skeletal fractures, and liver disease. The seven categories of adverse childhood experiences were strongly interrelated and persons with multiple categories of childhood exposure were likely to have multiple health risk factors later in life. CONCLUSIONS: We found a strong graded relationship between the breadth of exposure to abuse or household dysfunction during childhood and multiple risk factors for several of the leading causes of death in adults.

Vital signs: births to teens aged 15-17 years--United States, 1991-2012.

BACKGROUND: Teens who give birth at age 15-17 years are at increased risk for adverse medical and social outcomes of teen pregnancy. METHODS: To examine trends in the rate and proportion of births to teens aged 15-19 years that were to teens aged 15-17 years, CDC analyzed 1991-2012 National Vital Statistics System data. National Survey of Family Growth (NSFG) data from 2006-2010 were used to examine sexual experience, contraceptive use, and receipt of prevention opportunities among female teens aged 15-17 years. RESULTS: During 1991-2012, the rate of births per 1,000 teens declined from 17.9 to 5.4 for teens aged 15 years, 36.9 to 12.9 for those aged 16 years, and 60.6 to 23.7 for those aged 17 years. In 2012, the birth rate per 1,000 teens aged 15-17 years was higher for Hispanics (25.5), non-Hispanic blacks (21.9), and American Indians/Alaska Natives (17.0) compared with non-Hispanic whites (8.4) and Asians/Pacific Islanders (4.1). The rate also varied by state, ranging from 6.2 per 1,000 teens aged 15-17 years in New Hampshire to 29.0 in the District of Columbia. In 2012, there were 86,423 births to teens aged 15-17 years, accounting for 28% of all births to teens aged 15-19 years. This percentage declined from 36% in 1991 to 28% in 2012 (p<0.001). NSFG data for 2006-2010 indicate that although 91% of female teens aged 15-17 years received formal sex education on birth control or how to say no to sex, 24% had not spoken with parents about either topic; among sexually experienced female teens, 83% reported no formal sex education before first sex. Among currently sexually active female teens (those who had sex within 3 months of the survey) aged 15-17 years, 58% used clinical birth control services in the past 12 months, and 92% used contraception at last sex; however, only 1% used the most effective reversible contraceptive methods. CONCLUSIONS: Births to teens aged 15-17 years have declined but still account for approximately one quarter of births to teens aged 15-19 years. IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: These data highlight opportunities to increase younger teens exposure to interventions that delay initiation of sex and provide contraceptive services for those who are sexually active; these strategies include support for evidence-based programs that reach youths before they initiate sex, resources for parents in talking to teens about sex and contraception, and access to reproductive health-care services.