Study Objective National guidelines recommend annual Chlamydia trachomatis and Neisseria gonorrhea screening for sexually active youth at-risk for infection. These infections have serious sequelae in women if untreated, and methods to improve testing are needed. We hypothesized that an electronic method of identifying at-risk youth would significantly increase testing for these sexually transmitted infections during emergency department (ED) visits. Methods We developed an audio-enhanced computer-assisted self-interview (ACASI) to obtain sexual histories from ED patients and an embedded decision-tree to create an STI testing recommendation. ED healthcare providers were prompted via the electronic medical record to review the participant answers and testing recommendations, and to offer testing to at-risk youth. Patients 15-21 years old visiting the St. Louis Children's Hospital ED, regardless of complaint, were eligible for participation. Results STI testing among all 15-21 year old ED patients increased from 9.3% in the three months prior to the ACASI, to 17.8% during the eight-month period the ACASI was available, and diminished to 12.4% in the three months after ACASI withdrawal (P<0.001). During the ACASI period we approached 51.4% of eligible patients and enrolled 59.8% (800/1337) of those approached. Among ACASI participants, 52.4% (419/800) received a recommendation to receive STI testing. Of these, 52.7% (221/419) received testing in the ED, and 18.1% (40/221) of those tested were positive for chlamydia and/or gonorrhea, 55% of whom (22/40) had chief complaints unrelated to STIs. Most (89%) participants rated the ACASI easy to use. Conclusions STI testing in the ED significantly increased during ACASI use and diminished after withdrawal. The ACASI was well accepted by youth and holds promise for enhancing STI testing in the ED.

Purpose To compare risk for teen pregnancies between children living in poverty with no Child Protection Services (CPS) report history, and those in poverty with a history of CPS report. Methods Children selected from families in poverty, both with and without CPS report histories were prospectively followed from 1993–2009 using electronic administrative records from agencies including child protective services, emergency departments, Medicaid services and juvenile courts. A total of 3281 adolescent females were followed until age 18. Results For teens with history of poverty only, 16.8% had been pregnant at least once by age 17. In teens with history of both poverty and report of child abuse or neglect, 28.9% had been pregnant at least once by age 17. While multivariate survival analyses revealed several other significant factors at the family and youth services levels, a report of maltreatment remained significant (about a 66% higher risk). Conclusions Maltreatment is a significant risk factor for teen pregnancy among low income youth even after controlling for neighborhood disadvantage, other caregiver risks and indicators of individual emotional and behavioral problems.

ABSTRACT. The American Academy of Pediatrics policy statement "The Pediatrician's Role in Community Pediatrics" encourages all pediatricians to partner with their communities to create and disseminate innovative programs that improve child health. This article describes 4 pillars of a bridge to evidence-based community pediatrics for pediatricians interested in pursuing effective community action: (1) collaborate with the community to establish a specific, short-term, health-related goal; (2) identify evidence-based best practice(s) for achieving the shared goal; (3) collaborate with the community to adapt this best practice to the community's unique assets and constraints; and (4) evaluate the project by using appropriate expertise. Practical elements of each pillar are described and illustrated by specific examples from community-based efforts of pediatricians and are accompanied by specific resources to aid pediatricians in their future community health work. Pediatrics 2005;115: 1142-1147; community-based participatory research, community pediatrics, evidence-based medicine.

Background: Sexually transmitted infection (STI) prevention programs can decrease the economic burden of STIs. Foster youth have higher rates of STIs compared with their peers; however, information on direct costs and indirect costs averted by STI testing, treatment, and counseling among foster youth is lacking.Methods: This study used data from a comprehensive medical center for foster youth over a 3-year study period from July 2017 to June 2020. Direct and indirect costs averted by testing and treatment of chlamydia, gonorrhea, and syphilis, as well as HIV testing and counseling, were calculated based on formulas developed by the Centers for Disease Control and Prevention and adjusted for inflation.Results: Among the 316 youth who received medical services during this time, 206 were sexually active and tested for STIs and/or HIV. Among 121 positive STI test results, 64.5% (n = 78) were positive for chlamydia, 30.6% (n = 37) were positive for gonorrhea, and 5.0% (n = 6) were positive for syphilis.

No abstract