Exploration of the Adolescent Confidential Health History Screening-Tool and its Data at Denver Health in 2011 Público

Knechtle, William (2013)

Permanent URL: https://etd.library.emory.edu/concern/etds/rn301205b?locale=es
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Abstract

Background: Denver Health medical care providers developed a new adolescent patient health history screening-tool and wanted to learn if it was being used, how it was being used, if there was significant variation in health risk by demographic factors, and if the tool could be used to generate other hypotheses about adolescent health risk behaviors in Denver. The Adolescent Confidential Health History (ACHH) screening-tool was developed from the AMA's Guidelines for Adolescent Preventive Services (GAPS) questionnaire in 2009 and was used to direct counseling and treatment during Denver Health Well-Child Visits in 2011.

Methods: Secondary data analysis and interviews of Denver Health medical providers were used to explore ACHH screening-tool use and data. The number of adolescent patients completing the screening tool of the number expected at each health center was defined. Responses from 428 screening-tools completed at Eastside Family Health Center in 2011 were used to describe occurrence of and associations between health behaviors in the patient population. Outcomes of interest were sexual experience, marijuana use, and sleeping trouble. Health behaviors within the sample were compared to trends observed in the Healthy Kids Colorado Survey and the Youth Risk Behavior Survey. SQL Server Management Studio 2008 and Microsoft Access 2007 were used to create a database. SAS Enterprise Guide 4.2 and SAS 9.3 were used to analyze data.

Key Results: Significant variation in health risk by race occurred and is described in this thesis. Sexual experience and marijuana use did not differ greatly between males and females, though they did between races. Report of sleeping trouble differed between males and females (23.1% of males and 42.6% of females). Gender modified the association between health risk behaviors and sleeping trouble. Among female patients at Eastside Family Health Center, stress and sadness were more strongly associated with sleeping trouble than stress and sadness among males.

Conclusions: Reducing sadness and stress may reduce sleeping trouble (and vice versa) most efficiently among females. The Adolescent Confidential Health History will be an effective research tool if it is completed more widely and with less variation across Denver Health family and school-based health centers.

Table of Contents

TABLE OF CONTENTS

CHAPTER 1: INTRODUCTION (pg. 1)

CHAPTER 2: COMPREHENSIVE REVIEW OF THE LITERATURE (pg. 3)

History of Guidelines for Adolescent Preventive Services (GAPS)

Successes and Failures of the GAPS tool

Summary of Barriers to Use of the GAPS Screening-Tool

Summary of Barriers to Adolescent Care

Adolescent Concerns post-2010: The United States and Denver

Summary of GAPS-related literature review

CHAPTER 3: METHODOLOGY (pg. 16)

Understanding Denver Health's "Adolescent Confidential Health History"

Gibson Eastside Family Health Center: A Denver Health Opportunity

Initial Concerns and Limitations

Methods: (pg. 23)

Aim 1: Find who completes the ACHH

Aim 2: Describe Denver Health adolescents.

Aim 3: Analyze associations between health behaviors.

Results: (pg. 29)

Aim 1: Observed Adolescent Health Screening-Tools Administered

Bivariate Associations, Focus on Gender and Race

Grouping Questions by Category, Associations with Categories

Effect Modification by Gender: More focus on Sleeping Troubles

Similarity of Responses between Question Pairs

Associative Logistic Modeling Using P-Values

CHAPTER 4: DISCUSSION (pg. 43)

Summary of Results and How They Guide This Discussion

Completing the Adolescent Confidential Health History screening-tool

Limitations to Analysis

Bivariate Associations

Grouping Questions by Category

Similarity of Responses Between Question Pairs for Individual Patients

Sleeping Trouble, Gender, and Health Risk Behaviors

Comparing EFHC Data to Healthy Kids Colorado Data

Comparing EFHC Data to YRBS National Data

CHAPTER 5: WHAT I HAVE LEARNED (pg. 62)

REFERENCES

APPENDICES 1-8.

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