Though vaccine uptake and public support have risen since the release of the first HPV vaccines, the United States has far lower initiation and completion rates for the HPV vaccine series in comparison to other vaccines indicated for youth. Disparities are even greater in the Appalachian regions. Understanding factors contributing to these discrepancies is vital to improving vaccine rates in Appalachia. A comprehensive literature search identified all articles pertaining to HPV vaccination in children and adolescents living in Appalachia. The final 15 articles were included in a systematic review of the topic.

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Book Summary: Break the Cycle of Children’s Environmental Health Disparities (or simply, Break the Cycle) is an annual collaborative interdisciplinary research and training program involving university students in academic tracks that focus on the impact of adverse social, economic, and environmental factors on children’s health, development, and education. The target populations are communities where environmental hazards are related to circumstances of social and economic disadvantage. Each student develops a project that focuses on preventing or reducing adverse environmental factors to benefit the children who live in these communities. At the end of the project, the students present their studies and findings at a national conference and write papers which are then published. This book is the result of the 12th annual Break the Cycle program. The projects cover a range of factors that operate over a period of time and have an influence on individual, community, and social perspectives. Most importantly, they inform us about children’s environmental health disparities and propose solutions to reduce health disparities in order to promote health equity for all children.

Book Summary: This book is really a reflection of the past more than 20 years of work with teens and suicide prevention in the state of Kentucky. The work to establish the “Stop Youth Suicide Campaign (SYS)” has resulted in contact with many young adults, and we have found that the most important thing for all of them was finding a caring person they trust and can talk to. Because of the constant need, the SYS went from a goal of being a one year awareness campaign to becoming a major community resource, working with the state and local governments and state legislators to add as many resources as possible. We have witnessed for the first time a drop of youth suicide rates below the national average, according to the 2013 Youth Risk Behavior Surveillance done biannually by the Center for Disease Control. In this book, we will tackle various topics and specific populations in relation to suicide written by people who work with teens and care about them.

Abstract available in the American Journal of Obstetrics & Gynecology.

Background: Disadvantaged social, economic, and environmental factors create Adverse Childhood Experiences (ACEs), which can harm a child’s developing brain and have lasting effects on health. These experiences range from physical, emotional, or sexual abuse to parental divorce or substance abuse. Afflicted children have a significantly increased risk of behavioral and health issues later in childhood, as well as adult onset chronic health problems. We hypothesize that primary care ACEs screening, intervention by a primary care-behavior health care integrated care team, and referrals for parenting support and resources will be feasible, acceptable, and beneficial from parent and provider perspectives. Methods: Parents with an ACE score of four or higher at the one-month checkup will be offered The Incredible Years interactive video intervention during checkups through 9 months of age. Parents or children with an ACE score of four or higher at the 1-4 year well child visits will be referred to participate in Nurturing Parenting group visits provided by a partnering community agency. Both programs are evidence-based, family-centered trauma-informed programs supporting positive child rearing practices. Process and outcome variables will be assessed using surveys administered after patient screening and following each program session, and primary care providers will be surveyed at the end of the project period. Process and outcome measures include; number of families screened for ACEs, number referred to parenting programs, the number of program sessions completed and attendance and changes in selfassessed parenting competence. This study will demonstrate the feasibility of integrating traumainformed practices into primary pediatric care, document an increase in referrals to community support services and document an increase in self assessed parenting competence among parents who have suffered 4 or more ACEs. Results: Preliminary survey results show that families evaluate the process of undergoing ACEs screening and follow up discussion with providers in a favorable manner. Additionally, families with elevated ACEs scores that meet criteria for additional interventions, received the corresponding program in as acceptable and appropriate. Provider surveys are forthcoming, however the additional screening, intervention provided by the Behavioral Health Team, and feasibility survey collection has not affected the clinic’s productivity or delayed patient care. Upon initially starting screening and survey administration at clinic, an error was noted in the reporting of ACEs screening results in the EMR. Data collection was delayed while the EMR function was edited by IT administrator. Conclusions: Our multidisciplinary team will continue to collect data and continue to evaluate and streamline all aspects of the project in order to enhance the care of our patients and families. Additionally, will evaluate concerns and recommendations noted with provider administration survey at conclusion of data collection.

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