Current Research and Scholarly Interests
Confidentiality and Access to Care for Adolescents and Young Adults:
Adolescent preventive care guidelines recommend screening and counseling for healthy and risky behaviors. This requires confidential discussions between clinicians and young people, often, but not always in the context of parents’ involvement in their children’s care. In the US, only about half of all adolescents have ever had a private 1 on 1 discussion with their clinician without other people in the exam room. Thus, recommended screening and counseling is often not completed. Relatively little is known about the factors that would shift the dynamics of the parent, teen, clinician triads towards better quality adolescent health care delivery. The continued evolution of electronic health record interoperability presents additional challenges and opportunities for young people, their caregivers, and their clinicians.
Ongoing and planned work in this area includes 1) qualitative and quantitative studies of the delivery of and receipt of care by adolescents and young adults and barriers and facilitators of confidential time during well-visits; 2) policy analyses addressing changes in electronic health records confidentiality provisions, quality of care measures, and access to care in US States; and 3) policy analyses addressing global adolescent health delivery by front line health workers and accountability measures for adolescent health and well-being commitments by countries and other health system stakeholders during the 2023 Global Forum for Adolescents.
Tobacco, nicotine, and second-hand smoke prevention research:
1. Despite abundant evidence for the harm of tobacco and nicotine, marketing continues to be vigorously targeting adolescents and young adults, and many become addicted users. Dual use of E cigarettes remains highly prevalent and dual use of nicotine and marijuana is also common for young people. Many youth both know they are addicted, want to quit and have tried unsuccessfully to do so. Cessation counseling techniques and cessation adjuncts that are effective for youth are needed, but evidence for effective interventions remains limited. Building on previous randomized trials of cessation counseling for adolescence, we are planning and will conduct additional preliminary studies needed for a successful primary care practice-based intervention to reduce nicotine addiction in adolescents.
2. Second-hand smoke exposure is responsible for significant proportions of tobacco related diseases. Protecting non-smokers from secondhand smoke (SHS) exposure (and secondhand vapor exposure) is an important component of risk-reduction counseling as well as important in tobacco cessation. Two decades of evidence-based advocacy in child health has reduced childrens’ SHS exposure and lead to increased rates of risk reduction counseling for clean air around children, and smoke-free homes and cars. Many adults, including those at high risk for adverse health outcome from exposure (such as those with cardiac and pulmonary disease,) receive little or no secondhand smoke exposure reduction advice. We have done preliminary work with vascular surgeons to identify opportunities to change this trajectory through motivating clinical systems and documentation changes salient to reduction in procedure complication rates; follow-up qualitative study and documentation of this preliminary work in vascular surgery is planned. We will identify partners and funding streams and launch a similar intervention in neurology and geriatric medicine for people with Alzheimer’s disease, and will also explore opportunities to use these strategies with other medical and surgical specialties.
