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• 21. [Article] Putting Regulatory Data to Work at the Service of Public Health: Utilizing Data Collected Under the Clean Water Act

  Under the Clean Water Act, the US Environmental Protection Agency (EPA) collects information from states on intended use and impairment of each water body. We explore the feasibility of using these data, ...

  Citation × Citation Citation Abstract Copy Title: Putting Regulatory Data to Work at the Service of Public Health: Utilizing Data Collected Under the Clean Water Act Author: Jagai, Jyotsna S., Rosenbaum, Barbara J., Pierson, Suzanne M., Messer, Lynne C., Rappazzo, Kristen M., Naumova, Elena N., Lobdell, Danelle T. Year: 2013 Under the Clean Water Act, the US Environmental Protection Agency (EPA) collects information from states on intended use and impairment of each water body. We explore the feasibility of using these data, collected for regulatory purposes, for public health analyses. Combining EPA impairment data and stream hydrology information we estimated the percent of stream length impaired for any use, recreational use, or drinking water use per county in the US as exposure variables. For health outcomes we abstracted county-level hospitalization rates of gastrointestinal infections, GI (ICD-9CM 001-009 excluding 008.45) and gastrointestinal symptoms, GS (ICD-9CM 558.9, 787) among US adults aged 65 years and older from the Center for Medicare and Medicaid Services (1991–2004). Linear mixed-effects models were used to assess county-level associations between percent impaired waters and hospitalization rates adjusted for population density, a proxy for person-to-person transmission. Contrary to expectation, both GI and GS were negatively associated with any water impairment in adjusted models (GI: −0.052, 95 % CI: −0.077, −0.028; GS: −0.438, 95 % CI: −0.702, −0.174). GI was also negatively associated with recreational water impairment (−0.079, 95 % CI: −0.123, −0.036 after adjustment). Neither outcome was associated with drinking water impairment. Limited state data were reported to the EPA for specific recreational (27 states) and drinking (13 states) water impairment, thus limiting the power of the study. Though limited, this analysis demonstrates the feasibility of utilizing regulatory data for public health analyses. Title: Putting Regulatory Data to Work at the Service of Public Health: Utilizing Data Collected Under the Clean Water Act Author: Jagai, Jyotsna S., Rosenbaum, Barbara J., Pierson, Suzanne M., Messer, Lynne C., Rappazzo, Kristen M., Naumova, Elena N., Lobdell, Danelle T. Year: 2013 Under the Clean Water Act, the US Environmental Protection Agency (EPA) collects information from states on intended use and impairment of each water body. We explore the feasibility of using these data, collected for regulatory purposes, for public health analyses. Combining EPA impairment data and stream hydrology information we estimated the percent of stream length impaired for any use, recreational use, or drinking water use per county in the US as exposure variables. For health outcomes we abstracted county-level hospitalization rates of gastrointestinal infections, GI (ICD-9CM 001-009 excluding 008.45) and gastrointestinal symptoms, GS (ICD-9CM 558.9, 787) among US adults aged 65 years and older from the Center for Medicare and Medicaid Services (1991–2004). Linear mixed-effects models were used to assess county-level associations between percent impaired waters and hospitalization rates adjusted for population density, a proxy for person-to-person transmission. Contrary to expectation, both GI and GS were negatively associated with any water impairment in adjusted models (GI: −0.052, 95 % CI: −0.077, −0.028; GS: −0.438, 95 % CI: −0.702, −0.174). GI was also negatively associated with recreational water impairment (−0.079, 95 % CI: −0.123, −0.036 after adjustment). Neither outcome was associated with drinking water impairment. Limited state data were reported to the EPA for specific recreational (27 states) and drinking (13 states) water impairment, thus limiting the power of the study. Though limited, this analysis demonstrates the feasibility of utilizing regulatory data for public health analyses. Close

• 22. [Article] Needs, Costs, and Funding Alternatives for Transportation Services for Older Adults and People with Disabilities in Urban and Rural Oregon

  Portland State University's Institute on Aging and Center for Transportation Studies, along with the Population Research Center, were contracted by the Oregon Department of Transportation (ODOT), via the ...

  Citation × Citation Citation Abstract Copy Title: Needs, Costs, and Funding Alternatives for Transportation Services for Older Adults and People with Disabilities in Urban and Rural Oregon Author: Dill, Jennifer, Neal, Margaret B., Lycan, Richard, Delahanty, Ray, Jacobson, Talia, Smith, Kelly, Tipper, Ariana Year: 2008 Portland State University's Institute on Aging and Center for Transportation Studies, along with the Population Research Center, were contracted by the Oregon Department of Transportation (ODOT), via the Association of Counties, to project the transportation needs and associated costs for elders and people with disabilities from now to 2030. The study also identified and assessed the feasibility of funding alternatives to address the needs identified. Conducted by a multidisciplinary team of faculty and graduate students, the project was guided by a work group whose membership consisted of ODOT and Department of Human Services (DHS) employees and other stakeholders, and by a steering committee composed of various other stakeholders. Both groups provided feedback, ensured the interests of affected parties were addressed, and provided a forum for public input. There also was a public comment period. Existing sources of information were used, including census data, studies identified through an extensive review of the literature, statewide reports such as the Oregon DHS report on the Future of Long Term Care, locally adopted transportation plans, and ODOT public transit operations data. Once the use of and costs pertaining to existing transit service were established, the gap between the current level of service delivery and unmet needs for service was determined, and cost projections were made based on both, using an inflation factor determined in concert with the advisory groups. The findings and policy implications of the study are described, along with future research needs. Title: Needs, Costs, and Funding Alternatives for Transportation Services for Older Adults and People with Disabilities in Urban and Rural Oregon Author: Dill, Jennifer, Neal, Margaret B., Lycan, Richard, Delahanty, Ray, Jacobson, Talia, Smith, Kelly, Tipper, Ariana Year: 2008 Portland State University's Institute on Aging and Center for Transportation Studies, along with the Population Research Center, were contracted by the Oregon Department of Transportation (ODOT), via the Association of Counties, to project the transportation needs and associated costs for elders and people with disabilities from now to 2030. The study also identified and assessed the feasibility of funding alternatives to address the needs identified. Conducted by a multidisciplinary team of faculty and graduate students, the project was guided by a work group whose membership consisted of ODOT and Department of Human Services (DHS) employees and other stakeholders, and by a steering committee composed of various other stakeholders. Both groups provided feedback, ensured the interests of affected parties were addressed, and provided a forum for public input. There also was a public comment period. Existing sources of information were used, including census data, studies identified through an extensive review of the literature, statewide reports such as the Oregon DHS report on the Future of Long Term Care, locally adopted transportation plans, and ODOT public transit operations data. Once the use of and costs pertaining to existing transit service were established, the gap between the current level of service delivery and unmet needs for service was determined, and cost projections were made based on both, using an inflation factor determined in concert with the advisory groups. The findings and policy implications of the study are described, along with future research needs. Close

• 23. [Article] The Grand Challenge of Ending Homelessness

  The notion that homelessness in the United States can be ended, rather than managed, represents a fundamental shift in expectations that has occurred over the past three decades. Many U.S. cities now have ...

  Citation × Citation Citation Abstract Copy Title: The Grand Challenge of Ending Homelessness Author: Henwood, Benjamin, Wenzel, Suzanne L., Mangano, Philip F., Hombs, MaryEllen, Padgett, Deborah K., Byrne, Thomas, Rice, Eric, Butts, Sarah, Uretsky, Mathew C, Year: 2015 The notion that homelessness in the United States can be ended, rather than managed, represents a fundamental shift in expectations that has occurred over the past three decades. Many U.S. cities now have plans to end homelessness. Yet homelessness and housing instability are substantial problems that afflict a diverse group of subpopulations such as families, youth, veterans, and chronically homeless single adults. Ending homelessness for each of these populations may require tailored interventions that are responsive to specific individualized needs. These factors make tackling homelessness a difficult task. Although evidencebased solutions exist for some subpopulations, such as housing first for chronically homeless adults, scaling up best practices remains a challenge. For other subpopulations, such as transitional aged youth, evidence-based interventions need to be developed. In this paper we argue that ending homelessness is a Grand Challenge that is big, important, and compelling—one that the profession of social work should be adopt. Meeting this challenge will require a focused, organized response from social work researchers, clinicians, and policymakers. Ending homelessness will require innovation and interdisciplinary or cross-sector collaboration. Title: The Grand Challenge of Ending Homelessness Author: Henwood, Benjamin, Wenzel, Suzanne L., Mangano, Philip F., Hombs, MaryEllen, Padgett, Deborah K., Byrne, Thomas, Rice, Eric, Butts, Sarah, Uretsky, Mathew C, Year: 2015 The notion that homelessness in the United States can be ended, rather than managed, represents a fundamental shift in expectations that has occurred over the past three decades. Many U.S. cities now have plans to end homelessness. Yet homelessness and housing instability are substantial problems that afflict a diverse group of subpopulations such as families, youth, veterans, and chronically homeless single adults. Ending homelessness for each of these populations may require tailored interventions that are responsive to specific individualized needs. These factors make tackling homelessness a difficult task. Although evidencebased solutions exist for some subpopulations, such as housing first for chronically homeless adults, scaling up best practices remains a challenge. For other subpopulations, such as transitional aged youth, evidence-based interventions need to be developed. In this paper we argue that ending homelessness is a Grand Challenge that is big, important, and compelling—one that the profession of social work should be adopt. Meeting this challenge will require a focused, organized response from social work researchers, clinicians, and policymakers. Ending homelessness will require innovation and interdisciplinary or cross-sector collaboration. Close

• 24. [Article] Child and Maternal Health in the Slavic Community: Insights on Assets and Priorities

  The Slavic community’s health is impacted by race and ethnicity, and also by issues that flow from being a newcomer community, and also from their status as refugees. They also bring to the U.S.A. cultural ...

  Citation × Citation Citation Abstract Copy Title: Child and Maternal Health in the Slavic Community: Insights on Assets and Priorities Author: Reyes, Marie-Elena, Curry-Stevens, Ann Year: 2015 The Slavic community’s health is impacted by race and ethnicity, and also by issues that flow from being a newcomer community, and also from their status as refugees. They also bring to the U.S.A. cultural orientation that is collectivist, and shared experiences of persecution and deep distrust of the government. As is detailed in this report, these experiences have an impact on health and wellbeing, and simultaneously have a detrimental effect on the economic stature of the community. This Community Needs Assessment on the Health of Slavic Children (ages 0-5 years) was conducted to produce a “needs assessment” report outlining specific health concerns, needs and indicators of health disparities within the Slavic community, best practices from other Slavic communities, and recommendations for next steps to address disparities in a culturally competent change in policy or practices. The community opted to conduct two major data gathering processes: a maternal and child survey, and focus groups with mothers. We supplemented this information with a literature review to highlight both the larger social and economic issues that are well-tied to health (such as income, poverty, school engagement and English language skills), alongside studies that have identified health assets and challenges in both Slavic and immigrant communities. The core priority of the community are to establish a Slavic Health Center where providers will share their language, culture and history, and where health needs will be understood in their cultural context, and the distrust that typifies the relationships that many in the community have with formal health and social services will be eliminated. The need for this is strong, in evidence through the survey, the focus groups and in the literature. Specialized services are warranted to address the health issues tied to being newcomer communities, and in holding cultural identities and experiences that diverge significantly from that of mainstream (white) society. Additional priorities include rectifying the deep divide that exists on the issue of immunizations, with this being the highest priority health issue for mothers with young children. Second on the priority list is for parents to be well prepared for their children to arrive at school, and to help make this transition easier on both parents and children. Third is to address a wide range of issues tied to health promotion, including learning and responding to issues of child neglect and the conditions that will promote family stability. Fourth is oral health, and the importance of being able to see Slavic oral health providers. Across the spectrum is a need for information on services available, as well as making such services available, and making them culturally responsive. Taking action on two levels is key for the community: putting empowerment-based information into the hands of Slavic families, and catalyzing among service providers enhanced abilities to serve the Slavic community in respectful and culturally dignified ways. Health disparities faced by Slavic community members are inequitably measured, simply because their race/ethnicity is not separated out from “White” in the vast majority of research studies. Unfortunately, data cannot be separated by NWHF’s equity priorities like ethnicity overall, and cultural or linguistic background in particular. Culturally and linguistically specific services targeting this community’s needs are less likely than other disadvantaged communities of color such as African American and Native American, particularly due to inadequate gathering of data beyond the traditional racial and ethnic breakdown. Geography impacts this community’s health simply because of poverty-driven gentrification and the likelihood of Slavic families living in low-income diverse neighborhoods with greater risks of health disparities such as high obesity prevalence and chronic disease. Low-income neighborhoods where some of these families reside are less likely to have culturally and linguistically specific services targeting healthy choices and behaviors. Title: Child and Maternal Health in the Slavic Community: Insights on Assets and Priorities Author: Reyes, Marie-Elena, Curry-Stevens, Ann Year: 2015 The Slavic community’s health is impacted by race and ethnicity, and also by issues that flow from being a newcomer community, and also from their status as refugees. They also bring to the U.S.A. cultural orientation that is collectivist, and shared experiences of persecution and deep distrust of the government. As is detailed in this report, these experiences have an impact on health and wellbeing, and simultaneously have a detrimental effect on the economic stature of the community. This Community Needs Assessment on the Health of Slavic Children (ages 0-5 years) was conducted to produce a “needs assessment” report outlining specific health concerns, needs and indicators of health disparities within the Slavic community, best practices from other Slavic communities, and recommendations for next steps to address disparities in a culturally competent change in policy or practices. The community opted to conduct two major data gathering processes: a maternal and child survey, and focus groups with mothers. We supplemented this information with a literature review to highlight both the larger social and economic issues that are well-tied to health (such as income, poverty, school engagement and English language skills), alongside studies that have identified health assets and challenges in both Slavic and immigrant communities. The core priority of the community are to establish a Slavic Health Center where providers will share their language, culture and history, and where health needs will be understood in their cultural context, and the distrust that typifies the relationships that many in the community have with formal health and social services will be eliminated. The need for this is strong, in evidence through the survey, the focus groups and in the literature. Specialized services are warranted to address the health issues tied to being newcomer communities, and in holding cultural identities and experiences that diverge significantly from that of mainstream (white) society. Additional priorities include rectifying the deep divide that exists on the issue of immunizations, with this being the highest priority health issue for mothers with young children. Second on the priority list is for parents to be well prepared for their children to arrive at school, and to help make this transition easier on both parents and children. Third is to address a wide range of issues tied to health promotion, including learning and responding to issues of child neglect and the conditions that will promote family stability. Fourth is oral health, and the importance of being able to see Slavic oral health providers. Across the spectrum is a need for information on services available, as well as making such services available, and making them culturally responsive. Taking action on two levels is key for the community: putting empowerment-based information into the hands of Slavic families, and catalyzing among service providers enhanced abilities to serve the Slavic community in respectful and culturally dignified ways. Health disparities faced by Slavic community members are inequitably measured, simply because their race/ethnicity is not separated out from “White” in the vast majority of research studies. Unfortunately, data cannot be separated by NWHF’s equity priorities like ethnicity overall, and cultural or linguistic background in particular. Culturally and linguistically specific services targeting this community’s needs are less likely than other disadvantaged communities of color such as African American and Native American, particularly due to inadequate gathering of data beyond the traditional racial and ethnic breakdown. Geography impacts this community’s health simply because of poverty-driven gentrification and the likelihood of Slavic families living in low-income diverse neighborhoods with greater risks of health disparities such as high obesity prevalence and chronic disease. Low-income neighborhoods where some of these families reside are less likely to have culturally and linguistically specific services targeting healthy choices and behaviors. Close

• 25. [Article] State Experiences with Affordable Housing Plus Services: Report to Seniors and Persons with Disabilities, On The Move

  Housing developers, providers, policy makers, and advocates, increasingly recognize that for some groups of individuals, access to affordable housing alone is "not enough." That is, some individuals require ...

  Citation × Citation Citation Abstract Copy Title: State Experiences with Affordable Housing Plus Services: Report to Seniors and Persons with Disabilities, On The Move Author: Carder, Paula C., Zoller, Erika Year: 2009 Housing developers, providers, policy makers, and advocates, increasingly recognize that for some groups of individuals, access to affordable housing alone is "not enough." That is, some individuals require more than shelter. Examples include individuals who have chronic health conditions (e.g., HIV/AIDS), those with physical or cognitive limitations (e.g., persons with developmental disabilities, adults with physical disabilities), and those who have a combination of health conditions or who cannot thrive in traditional housing (e.g., persons who have been homeless, individuals with chronic mental illness). Increasingly, housing providers, social service agencies, advocates, states, and federal agencies have recognized the need to combine housing with supportive services designed to address the health and social needs of such groups and individuals. Older adults want to remain in their homes as long as possible (Bayer & Harper, 2000), and providing supportive services to them in their homes is one approach to preventing or delaying unnecessary institutionalization in an acute or long-term care facility (Gibson et. al., 2003). Increasingly, policy makers and advocates recognize that "homes" includes subsidized rental units occupied by older persons and adults with disabilities. There are a variety of affordable housing and service models across the United States, and they fall under a range of categories and terms (e.g., permanent supportive housing, enriched housing, affordable housing plus services). Whether or not some combination of housing and services can meet the needs of individuals transitioning out of nursing homes remains a question of interest to current nursing home residents, advocates, and policy makers. The purpose of this report is to describe examples of affordable housing plus services (AHPS) that might serve as models for Oregon’s On the Move demonstration project (a Centers for Medicare and Medicaid Services Money Follows the Person project). For this analysis, we reviewed existing reports and articles and collected information about policies and programs in several states in order to learn whether older adults and persons with disabilities, including those discharged from nursing homes, might be served by AHPS programs. Given that Oregon has a long history of providing home and community-based services, we focused primarily on unlicensed housing models rather than licensed residential settings such as assisted living and adult foster care. It is important to note that other states do not have as well-developed a home-and community based care network as does Oregon. Thus, for some states, assisted living is being promoted as a relatively new, and less expensive, alternative to institutionalization. In Oregon, one goal of creating nursing home alternatives is to expand individuals' choices to include affordable housing plus service options. Title: State Experiences with Affordable Housing Plus Services: Report to Seniors and Persons with Disabilities, On The Move Author: Carder, Paula C., Zoller, Erika Year: 2009 Housing developers, providers, policy makers, and advocates, increasingly recognize that for some groups of individuals, access to affordable housing alone is "not enough." That is, some individuals require more than shelter. Examples include individuals who have chronic health conditions (e.g., HIV/AIDS), those with physical or cognitive limitations (e.g., persons with developmental disabilities, adults with physical disabilities), and those who have a combination of health conditions or who cannot thrive in traditional housing (e.g., persons who have been homeless, individuals with chronic mental illness). Increasingly, housing providers, social service agencies, advocates, states, and federal agencies have recognized the need to combine housing with supportive services designed to address the health and social needs of such groups and individuals. Older adults want to remain in their homes as long as possible (Bayer & Harper, 2000), and providing supportive services to them in their homes is one approach to preventing or delaying unnecessary institutionalization in an acute or long-term care facility (Gibson et. al., 2003). Increasingly, policy makers and advocates recognize that "homes" includes subsidized rental units occupied by older persons and adults with disabilities. There are a variety of affordable housing and service models across the United States, and they fall under a range of categories and terms (e.g., permanent supportive housing, enriched housing, affordable housing plus services). Whether or not some combination of housing and services can meet the needs of individuals transitioning out of nursing homes remains a question of interest to current nursing home residents, advocates, and policy makers. The purpose of this report is to describe examples of affordable housing plus services (AHPS) that might serve as models for Oregon’s On the Move demonstration project (a Centers for Medicare and Medicaid Services Money Follows the Person project). For this analysis, we reviewed existing reports and articles and collected information about policies and programs in several states in order to learn whether older adults and persons with disabilities, including those discharged from nursing homes, might be served by AHPS programs. Given that Oregon has a long history of providing home and community-based services, we focused primarily on unlicensed housing models rather than licensed residential settings such as assisted living and adult foster care. It is important to note that other states do not have as well-developed a home-and community based care network as does Oregon. Thus, for some states, assisted living is being promoted as a relatively new, and less expensive, alternative to institutionalization. In Oregon, one goal of creating nursing home alternatives is to expand individuals' choices to include affordable housing plus service options. Close

• 26. [Article] Lane Transit District Integrated Functional Transportation Assessment Project: Findings from a Case Study and Developmental Evaluation

  This report describes the results of a case study and developmental evaluation of Lane Transit District's innovative project to develop an integrated functional assessment for transportation services, ...

  Citation × Citation Citation Abstract Copy Title: Lane Transit District Integrated Functional Transportation Assessment Project: Findings from a Case Study and Developmental Evaluation Author: Neal, Margaret B., Eliot, Susan, Person, Mark, Lottes, Jost Year: 2011 This report describes the results of a case study and developmental evaluation of Lane Transit District's innovative project to develop an integrated functional assessment for transportation services, referred to here simply as the Transportation Assessment Project (TAP). The TAP is unique in that it is a collaborative effort between a public transit agency and local human service agencies to blend traditionally separate assessments for eligibility for transportation services. Specifically, in the TAP, Lane Transit District subcontracts with human services agencies to conduct personalized in-home assessments with individuals with special transportation needs and who are requesting paratransit rides. While in the home assessing an individual’s transportation needs and abilities, human service workers act as a gateway to other social services, as well. The goal of the TAP is to provide access to the most appropriate transportation services when and where individuals need them, in the most personalized, streamlined, and cost-effective way. The TAP has been fully operational for one year following a development and start-up period. There has been considerable interest internally, in the state, and throughout the U.S. in how the project began and how it is working to date. As a result, the project's leaders boldly decided to commission a study. Conducted in the summer of 2011, this case study analysis generated a rich and multi-faceted picture, at one point in time, of this unique, collaborative project for assessing individuals’ transportation needs and capabilities while, at the same time, connecting people to the local human services network. Due to the early timing of the study (prior to the ability of the program to demonstrate attributable impacts), the study also serves as a process evaluation designed to document how the TAP was ideally supposed to work, how it is actuallyworking, and how it could be improved. In addition to the developmental findings, this report contains a detailed history and description of the TAP, an estimation of how easily the program can be replicated and recommendations for enhancement of this innovative human service-transportation delivery model. Because of the dynamic nature of the project, it is important to note that the findings reported here represent only a slice-in-time view. Already changes have been made in the project since the data were gathered and analyzed. Title: Lane Transit District Integrated Functional Transportation Assessment Project: Findings from a Case Study and Developmental Evaluation Author: Neal, Margaret B., Eliot, Susan, Person, Mark, Lottes, Jost Year: 2011 This report describes the results of a case study and developmental evaluation of Lane Transit District's innovative project to develop an integrated functional assessment for transportation services, referred to here simply as the Transportation Assessment Project (TAP). The TAP is unique in that it is a collaborative effort between a public transit agency and local human service agencies to blend traditionally separate assessments for eligibility for transportation services. Specifically, in the TAP, Lane Transit District subcontracts with human services agencies to conduct personalized in-home assessments with individuals with special transportation needs and who are requesting paratransit rides. While in the home assessing an individual’s transportation needs and abilities, human service workers act as a gateway to other social services, as well. The goal of the TAP is to provide access to the most appropriate transportation services when and where individuals need them, in the most personalized, streamlined, and cost-effective way. The TAP has been fully operational for one year following a development and start-up period. There has been considerable interest internally, in the state, and throughout the U.S. in how the project began and how it is working to date. As a result, the project's leaders boldly decided to commission a study. Conducted in the summer of 2011, this case study analysis generated a rich and multi-faceted picture, at one point in time, of this unique, collaborative project for assessing individuals’ transportation needs and capabilities while, at the same time, connecting people to the local human services network. Due to the early timing of the study (prior to the ability of the program to demonstrate attributable impacts), the study also serves as a process evaluation designed to document how the TAP was ideally supposed to work, how it is actuallyworking, and how it could be improved. In addition to the developmental findings, this report contains a detailed history and description of the TAP, an estimation of how easily the program can be replicated and recommendations for enhancement of this innovative human service-transportation delivery model. Because of the dynamic nature of the project, it is important to note that the findings reported here represent only a slice-in-time view. Already changes have been made in the project since the data were gathered and analyzed. Close

• 27. [Article] Potentially Traumatic Experiences and Sexual Health Among Orphaned and Separated Adolescents in Five Low- and Middle-Income Countries

  Orphans and separated children (OSC) are a vulnerable population whose numbers are increasing, particularly in sub-Saharan Africa and Asia. Over 153 million children worldwide have lost one or both parents, ...

  Citation × Citation Citation Abstract Copy Title: Potentially Traumatic Experiences and Sexual Health Among Orphaned and Separated Adolescents in Five Low- and Middle-Income Countries Author: Gray, Christine L., Whetten, Kathryn, Messer, Lynne C., Whetten, Rachel A., Ostermann, Jan, O'Donnell, Karen, Thielman, Nathan M., Pence, Brian W. Year: 2016 Orphans and separated children (OSC) are a vulnerable population whose numbers are increasing, particularly in sub-Saharan Africa and Asia. Over 153 million children worldwide have lost one or both parents, including 17 million orphaned by AIDS, and millions more have been separated from their parents. As younger orphans enter adolescence, their sexual health and HIV-related risk behaviors become key considerations for their overall health. Importantly, their high prevalence of exposure to potentially traumatic events (PTEs) may put OSC at additional risk for adverse sexual health outcomes. The Positive Outcomes for Orphans study followed OSC randomly sampled from institution-based care and from family-based care, as well as a convenience sample of non-OSC, at six sites in five low-and middle-income countries. This analysis focused on the 90-month followup, during which adolescents 16 and older were assessed for sexual health, including age at sexual debut, past-year sex, past-year condom use, and perceptions of condom use. We specifically examined the relationship between PTEs and sexual health outcomes. Of the 1258 OSC and 138 non-OSC assessed, 11% reported ever having sex. Approximately 6% of participants reported recent sex and 5% reported having recent unprotected sex. However, 70% of those who had recent sex reported that they did not use a condom every time, and perceptions of condom use tended to be unfavorable for protection against sexual risk behavior. Nearly all (90%) of participants reported experiencing at least one lifetime PTE. For those who experienced “any” PTE, we found increased prevalence of recent sex (PR = 1.39 [0.47, 4.07]) and of recent unprotected sex (PR = 3.47 [0.60, 19.91]). This study highlights the need for caregivers, program managers, and policymakers to promote condom use for sexually active OSC and identify interventions for trauma support services. Orphans living in family-based care may also be particularly vulnerable to early sexual debut and unprotected sexual activity. Title: Potentially Traumatic Experiences and Sexual Health Among Orphaned and Separated Adolescents in Five Low- and Middle-Income Countries Author: Gray, Christine L., Whetten, Kathryn, Messer, Lynne C., Whetten, Rachel A., Ostermann, Jan, O'Donnell, Karen, Thielman, Nathan M., Pence, Brian W. Year: 2016 Orphans and separated children (OSC) are a vulnerable population whose numbers are increasing, particularly in sub-Saharan Africa and Asia. Over 153 million children worldwide have lost one or both parents, including 17 million orphaned by AIDS, and millions more have been separated from their parents. As younger orphans enter adolescence, their sexual health and HIV-related risk behaviors become key considerations for their overall health. Importantly, their high prevalence of exposure to potentially traumatic events (PTEs) may put OSC at additional risk for adverse sexual health outcomes. The Positive Outcomes for Orphans study followed OSC randomly sampled from institution-based care and from family-based care, as well as a convenience sample of non-OSC, at six sites in five low-and middle-income countries. This analysis focused on the 90-month followup, during which adolescents 16 and older were assessed for sexual health, including age at sexual debut, past-year sex, past-year condom use, and perceptions of condom use. We specifically examined the relationship between PTEs and sexual health outcomes. Of the 1258 OSC and 138 non-OSC assessed, 11% reported ever having sex. Approximately 6% of participants reported recent sex and 5% reported having recent unprotected sex. However, 70% of those who had recent sex reported that they did not use a condom every time, and perceptions of condom use tended to be unfavorable for protection against sexual risk behavior. Nearly all (90%) of participants reported experiencing at least one lifetime PTE. For those who experienced “any” PTE, we found increased prevalence of recent sex (PR = 1.39 [0.47, 4.07]) and of recent unprotected sex (PR = 3.47 [0.60, 19.91]). This study highlights the need for caregivers, program managers, and policymakers to promote condom use for sexually active OSC and identify interventions for trauma support services. Orphans living in family-based care may also be particularly vulnerable to early sexual debut and unprotected sexual activity. Close