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Our findings highlight the need to develop and evaluate physician-focused trainings on using presumptive language for same-day HPV vaccination.

Context Previous epidemiological, animal, and human cognitive neuroscience research suggests that maternal smoking during pregnancy causes increased risk of offspring substance use/problems. Objective To determine the extent to which the association between SDP and offspring substance use/problems depends on confounded familial background factors by using a quasi-experimental design. Design We used two separate samples, from the United States and from Sweden, respectively. The analyses prospectively predicted multiple indices of substance use and problems while controlling for statistical covariates and comparing differentially exposed siblings to minimize confounding. Setting Sample 1: Offspring of a representative sample of women in the United States. Sample 2: The total Swedish population born over 13 years. Patients or Other Participants Sample 1: Adolescent offspring of the women in the National Longitudinal Survey of Youth 1979 (n=6,094). Sample 2: All offspring born in Sweden from 1983 through 1995 (n=1,187,360). Main Outcome Measures Sample 1: Self-reported adolescent alcohol, cigarette, and marijuana use, and early onset (before age 14 years) of each substance. Sample 2: Substance-related convictions and hospitalizations for an alcohol- or drug-related problem. Results The same pattern emerged for each index of substance use/problems across the two samples. At the population level maternal smoking during pregnancy predicted every measure of offspring substance use/problems in both samples, ranging from adolescent alcohol use (HRmoderate=1.32, CI=1.22–1.43; HRhigh=1.33, CI=1.17=1.53) to a narcotic convictions (HRmoderate=2.23, CI=2.14–2.31; HRhigh=2.97, CI=2.86–3.09). When comparing differentially exposed siblings to minimize genetic and environmental confounds, however, the association between SDP and each measure of substance use/problems was minimal and not statistically significant. Conclusions The association between maternal smoking during pregnancy and offspring substance use/problems was likely due to familial background factors, not a causal influence, because siblings had similar rates of substance use and problems regardless of their specific exposure to smoking during pregnancy.

Purpose Examine the effects of the timing of parents' relationship instability on adolescent sexual and mental health. Methods We assessed whether the timing of parents' relationship instability predicted adolescents' history of sexual partnerships and major depressive episodes. Multivariate logistic regression analyses controlled for potential mediators related to parenting and the family, including parent knowledge of activities, parent-child relationship quality, number of parents' post-separation relationship transitions, and number of available caregivers. Participants were assessed annually from age 5 through young adulthood as part of a multi-site community sample (N=585). Results Participants who experienced parents' relationship instability before age 5 were more likely to report sexual partnerships at age 16 (odds ratio [OR]adj=1.58) or an episode of major depression during adolescence (ORadj=2.61). Greater parent knowledge at age 12 decreased the odds of sexual partnerships at age 16, but none of the hypothesized parenting and family variables statistically mediated the association between early instability and sexual partnerships or major depressive episode. Conclusions These results suggest that experiencing parents' relationship instability in early childhood is associated with sexual behavior and major depression in adolescence, but these associations are not explained by the parenting and family variables included in our analyses. Limitations of the current study and implications for future research are discussed.

Objective The quadrivalent and 9-valent human papillomavirus (HPV) vaccines are licensed for administration among 9–26-year-old males and females, with routine vaccination recommended for 11–12-year-olds. Despite the availability of the vaccine at younger ages, few studies have explored vaccine uptake prior to age 13, and national HPV vaccination surveillance data is limited to 13–17-year-olds. Our objective was to examine rates and predictors of HPV vaccine initiation among 9–13-year-olds in the United States. Methods A national sample of mothers of 9–13-year-olds in the United States (N=2,446) completed a 2014 Web-based survey assessing socio-demographic characteristics, child’s HPV vaccination history, provider communication regarding the vaccine, and other attitudes and behaviors pertaining to vaccination and healthcare utilization. The main outcome measure was child’s initiation of the HPV vaccine (i.e., receipt of one or more doses). Results Approximately 35% of the full sample and 27.5% of the 9–10-year-olds had initiated HPV vaccination. Females were more likely than males to have initiated HPV vaccination by the age of 13 but not by younger ages. Strength of health provider recommendation regarding HPV vaccination was a particularly salient predictor of vaccine initiation. Conclusions Approximately a third of children may be initiating the HPV vaccine series before or during the targeted age range for routine administration of the vaccine. Because coverage remains below national targets, further research aimed at increasing vaccination during early adolescence is needed. Improving providers’ communication with parents about the HPV vaccine may be one potential mechanism for increasing vaccine coverage.