2018 Communities of Practice Conference Program

Department of Family and Community Medicine

National Center for Medical Education, Development and Research

Communities of Practice Conference May 31 – June 1, 2018 in Nashville, Tennessee | Nashville Marriott at Vanderbilt University

& A Curriculum Pathway Forward

Medical Education

Clinical Transformation

Meharry Medical College was recently funded by the Health Resources and Services Administration (HRSA) to establish a new academic administrative unit under grant number UH1HP30348. The new center is an academic unit (AU) housed in the Department of Family and Community Medicine at Meharry Medical College through a cooperative agreement with HRSA to evaluate the evidence-base for primary care interventions targeting vulnerable populations to transform primary care training in medical education and clinical practice in Tennessee and within the United States. For the purpose of this award, HRSA defined vulnerable populations as Lesbian, Gay, Bisexual, Transgender and Questioning (LGBTq), homeless persons, and migrant farm workers. The National Center for Medical Education, Development and Research (NCMEDR) goals are to 1) conduct systems-level research of evidence-based interventions for vulnerable populations to inform primary care training; 2) disseminate best practices and resources to primary care providers and trainees across the mid-South to improve clinical outcomes among vulnerable populations; and 3) establish a Community of Practice (CoP) that will promote the widespread enhancement and development of a diverse primary care workforce that will produce better health outcomes for LGBT, homeless and migrant worker populations. In addition, this new community of practice will assist the Center in identifying and providing curriculum transformation and innovation. It is anticipated that the CoP will give relevant and timely feedback on the development of toolkits including case studies for simulation, and provide educational models and coaching to primary care faculty to train residents and health professions students to deliver high quality, cost-effective, patient-centered care to vulnerable populations in under-served communities. The Center anticipates by linking clinical knowledge with the expertise of basic, clinical, and social science faculty and community partners in this new Center that we will strengthen capacity for engaging in multi-level, transdisciplinary and inter-professional primary care research and training. It is expected this engagement will assist other medical schools as they develop new curriculum to examine health disparities, health services, health equity, and primary care training from a systems framework using a life course model. Therefore, the charge of the CoP for Vulnerable Populations is to assist us in the development, identification, research, and feedback on the application of new tools in medical education that will enhance teaching and modeling of the provision of health care services to vulnerable populations through feedback and dissemination of ideas on medical education to primary care departments across the United States. The topics for our first year were: »» Identify how medical schools are teaching students to address implicit physician bias towards vulnerable populations; and »» Find out how they are preparing students to introduce preventive measures such as Pre-Exposure Prophylaxis (PrEP) to vulnerable patients in order to prevent HIV. Our second year topics included how medical schools are teaching students to address: »» Interpersonal violence across the lifespan; and »» The effects of adverse childhood experiences in these three vulnerable populations. Our proposed third year research topics will include how medical schools are teaching students to address: »» »» »» »»

Childhood and Adult Immunization Disparities; Opioid Misuse among Vulnerable Populations; Leveraging the Affordable Care Act to Address Needs of Homeless Populations; and Sexual Violence among Women who are LGBT, Homeless, or Migrant Farmworkers.

Dear Thought Leaders, Content and Subject Matter Experts. Welcome to Meharry Medical College and the National Center for Medical Education Development and Research (NCMEDR) second integrative Communities of Practice work group. As President and CEO, we thank you for serving as content and subject matter experts as well as your commitment to respond to the call to reflect and provide feedback on the work conducted by the faculty in the Center. Your ideas, concepts, and thoughts are needed to move the curriculum forward in medical education and clinical practice for Tennessee and the nation. The NCMEDR mandate is to implement a Community of Practice that addresses critical elements in the pedagogical processes to transform medical education and clinical practice in primary care in the United States. The main objective of the Center is to conduct research and to develop evidence-based curriculum and practices that will provide a path forward for medical schools to address the training needs of its medical students to provide health care services, while promoting health equity for LGBTq, homeless persons, and migrant farm workers. Equally as important to medical education nationally are the recommendations that are emanating from the findings of the research topics that have been chosen carefully with input from the faculty in the Center and from you, the members of the Communities of Practice. Your input, as content and subject matter experts, has been invaluable as the Center develops and disseminates the products of the Center. The products have been exceptional. The products have included two manuscripts, two policy briefs, twelve abstracts and twelve national presentations. One of the most effective presentations, this year, was the presentation by Drs. Paul Juarez, Pat Matthews-Juarez, and Katherine Brown at the American Association of Medical Colleges (AAMC) conference in Orlando. Partnering with the University of California at Davis, the Center placed the importance of promulgating public policy from medical education research findings on the national agenda in April 2018. The work of the Center is, therefore, extremely critical and important as we identify evidence-based outcomes that will lead to sustainable changes in medical education curricula as well as how to teach in the coming decade. New innovations in pedagogy are essential and must be realized as faculty and students expand their scope of work in team-based, patient centered care, inter-professional collaboration and precision medicine. The research of the Center examines the following topics: 1) how medical schools are teaching students to care for LGBTq, home persons, and migrant farm workers; 2) the content and quantity of the subject matter being taught, 3) access to health services, continuity of care, the care continuum, and 4) the focus of the interaction between physician and patient. Sincerely,

James E.K. Hildreth James E.K. Hildreth, PhD, MD President & Chief Executive Officer

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Meharry Medical College is an academic health sciences center that exists to improve the health and health care of minority and underserved communities by offering excellent education and training programs in the health sciences. True to its heritage, Meharry places special emphasis on providing opportunities for people of color, individuals from disadvantaged backgrounds, and others regardless of race or ethnicity; delivering high quality health services; and conducting research that fosters the elimination of health disparities

Welcome, Members of Communities of Practice! To promote medical education and clinical transformation in patient centered care for vulnerable populations, our goal in the National Center for Medical Education Development and Research is to conduct systems-level research on primary care training by evaluating evidence-based interventions that address the health care needs of LGBTq and Homeless Persons and Migrant Farm Workers defined as vulnerable populations. Currently, medical students and residents are familiar with a few concepts of the patient-centered care that include curricular lectures, utilization of Electronic Health Records, defining and implementing appropriate access, e-prescribing, utilization of chronic disease registries, rapid cycle quality improvement methods, email/other asynchronous communication, and referral tracking. Yet, there is no national standard for curricular implementation of patient-centeredness for medical students and residents in primary care training for addressing the needs of vulnerable populations as defined earlier. Curricular topics such as implicit basis and the prescribing of PrEP are not routinely addressed. This is especially true for the needs of patients who are LGBTq, homeless persons, or migrant farm workers. As content and subject matter experts, you are part of a process aimed at transforming medical education in primary care and primary care clinical practice. You also are part of a national conversation that is identifying the gaps in primary care training and linking performance, quality of care, and cost of health services to medical education and clinical practice. Your ideas, thoughts, knowledge, and experience will assist the Center in addressing the gaps in our research on primary care training using evidence-based studies aimed at bringing about the transformation of medical education that will benefit vulnerable populations. Thanks again for your contributions to our Center and the process of transforming primary care training. Best,

Pat Matthews-Juarez, PhD Project Director Professor Department of Family and Community Medicine Vice President, Faculty Affairs and Development Meharry Medical College

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Dear Colleagues, I would like to welcome and thank each of you for your participation in the 2018 NCMEDR Community of Practice (CoP) meeting. The CoP is comprised of persons with expertise in the needs of LGBTq, homeless persons, and migrant farmworkers; content experts on our research topics; and medical education faculty. Your combined wisdom, experiences, and insights are vital to the process of curriculum and practice transformation and will help us shape the training of medical students to better address the health needs of vulnerable populations. We are excited to have this opportunity to share with you the activities and accomplishments of the Center over the past year and get your feedback and insights as we move forward on how we can better prepare future primary care physicians to address the needs of vulnerable populations. Again, thank you for agreeing to participate, now let’s get to work.

Paul D. Juarez Paul D. Juarez, PhD Program Director NCMEDR

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Conference Summary The National Center for Medical Education, Development and Research (NCMEDR) at Meharry Medical College was funded in 2016 by Health Resources and Services Administration (HRSA) to provide leadership in primary care training and curriculum transformation by addressing the needs of vulnerable populations. For the purpose of this award, HRSA defined vulnerable populations as Lesbian, Gay, Bisexual, Transgender and Questioning (LGBTq), homeless persons, and migrant farm workers. The center is an academic unit (AU) housed in the Department of Family and Community Medicine to conduct systems research on how medical schools are addressing the needs of vulnerable populations and to make recommendations for medical education curriculum change that promotes health equity. The Center’s aims are to: »» conduct systems-level research of evidence-based interventions for vulnerable populations to inform primary care training; »» establish a Community of Practice (CoP) to assist the Center in identifying and making recommendations for curriculum transformation and innovation that will result in better health outcomes for LGBTq populations, homeless persons, and migrant farm worker populations; »» bring together academic faculty with community partners, advocates, and consumers to create an evidence-base for promoting health equity among vulnerable population; and »» disseminate medical education best practices and resources to the academic medicine community across the mid-South and nation to improve the health of vulnerable population. The Center will strengthen the national capacity to promote meaningful curriculum transformation by supporting a CoP that provides relevant and timely feedback and direction for the development of medical education curriculum. Educational toolkits are being developed through systematic reviews of the literature; surveys of medical educators, students, and health care consumers; videos and case studies for simulation; and other educational models and tools that can be used to prepare health professions students and medical residents in the delivery of primary care that is high quality, cost-effective, and patient-centered to vulnerable populations in under-served communities. It is expected that this Community of Practice process will serve as a national model for other medical schools seeking to develop new primary care curriculum that better address the needs of LGBTq populations, homeless persons, and migrant farm workers. The charge of the CoP for Vulnerable Populations is to assist the Center in the development, conduct and dissemination of medical education research to enhance primary care teaching that addresses the health care needs of vulnerable populations. Our first year topics were: »» Project 1: Training for Health Care Providers in the Administration of Pre-Exposure Prophylaxis to Men and Transgender Women who have Sex with Men: A Systematic Review This project examined the efficacy of PrEP and identified best practices in teaching medical students about prescribing PrEP. »» Project 2: Physician Bias Education of Medical Students in Providing Culturally Competent Care for Lesbian, Gay, Bisexual, and Transgender Patients (LGBT), Homeless Persons, and MIgrant Farm Workers The research study describes the methodology for establishing an evidence-based curriculum designed to reduce the effects of physician implicit bias among medical students to improve the provision of health care services to LGBTq populations, homeless persons, and migrant farm workers. Our second year topics included how medical schools are teaching students to address: »» Project 3: Exposure to interpersonal violence across the life course by vulnerable populations This research project examined how medical schools are teaching students to screen for and treat vulnerable populations exposed to interpersonal violence at different stages of life. »» Project 4: Adverse Childhood Experiences as experienced by vulnerable populations This research project examined how medical schools are teaching students to screen for and manage the effects of adverse childhood experiences in children and adults among LGBTq populations, homeless persons, and migrant farm workers. Our proposed third year topics are: »» Project 5: Childhood and Adult Immunization Disparities This research project seeks to identify how medical students are being taught to identify and address barriers to immunizations experienced by LGBTq populations, homeless persons, and migrant farm workers. »» Project 6: Opioid Misuse among Vulnerable Populations This research project seeks to identify how medical students are being taught to screen for and treat opioid misuse among persons from vulnerable populations. »» Project 7: Leveraging the Affordable Care Act to Address Needs of Homeless Populations This study seeks to identify what medical students are taught about Medicaid coverage for homelessness persons under the ACA. »» Project 8: Sexual Violence among Women who are LGBTq, Homeless, or Migrant Farmworkers This review seeks to identify and make recommendations on how medical schools are training students to screen for sexual violence among vulnerable populations and engage appropriate services and resources to assist them.

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What is a Community of Practice? A community of practice (CoP) is a group of people who share a craft or a profession. The concept was first proposed by cognitive anthropologist Jean Lave and educational theorist Etienne Wenger in their 1991 book Situated Learning (Lave & Wenger 1991). Wenger then significantly expanded on the concept in his 1998 book Communities of Practice (Wenger 1998). A CoP can evolve naturally because of the members’ common interest in a particular domain or area, or it can be created deliberately with the goal of gaining knowledge related to a specific field. It is through the process of sharing information and experiences with the group that members learn from each other, and have an opportunity to develop personally and professionally (Lave & Wenger 1991).

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Table of Contents

5 8 9 18 20 22 30 41 46

Conference Summary

Learn how NCMEDR and its Communities of Practice got started.

Program-at-a-Glance

Get an overview of what happens and when.

Agenda

Take notes and engage in dynamic discussions with our conference speakers.

Conference Faculty, Community Partners, & Staff We extend our appreciation to all conference faculty at the 2018 Conference.

Year 2 Research Projects

Take a look at the Center’s research within Adverse Childhood Experiences and Interpersonal Violence.

Proposed Year 3 Research Projects

Check out our proposed projects, and prepare for our presentation and discussion on Friday.

NCMEDR Research Policy Briefs

Read the Center’s systematic reviews of medical education, covering implicit bias and PrEP.

2017 Readings on Vulnerable Populations

View last year’s topic references on Physician Bias and Pre-Exposure Prophylaxis.

2018 Readings on Vulnerable Populations

View this year’s topic references on Adverse Childhood Experiences and Interpersonal Violence.

The Primary Care Training and Enhancement Academic Units (AU) project is supported in part through a cooperative agreement (UH1HP30348) with the US Department of Health and Human Services (DHHS)/Health Resources and Services Administration (HRSA) and Department of Family and Community Medicine, School of Medicine, Meharry Medical College. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by DHHS, HRSA or the U.S. Government.

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Program At-A-Glance DAY 1: THURSDAY, MAY 31, 2018 8:30 AM – 9:15 AM Acorn Ballroom Foyer

Continental Breakfast

9:00 AM – 11:30 AM Acorn Ballroom AB

Opening Session

11:30 AM – 2:00 PM Acorn Ballroom AB

Institutional Greetings & Lunch

Medical Education and Clinical Transformation: A Curriculum Pathway Forward

Medical Education Curriculum Transformation Keynote Presentation

Adverse Childhood Experiences and their Impact on Health 2:00 PM – 4:30 PM Acorn Ballrooms A, B, & C

Working Groups Session I

5:00 PM – 7:00 PM Crescent Room (2nd Floor)

Reception

Communities of Practice ACEs Working Groups: Homeless Persons, LGBTq Populations, & Migrant Farm Workers

Group Interactive Reception by Communities of Practice

DAY 2: FRIDAY, JUNE 1, 2018

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7:30 AM – 8:30 AM Acorn Ballroom Foyer

Continental Breakfast

7:55 AM – 8:50 AM Acorn Ballroom AB

Keynote Presentation

8:50 AM – 11:45 AM Acorn Ballrooms A, B, & C

Working Groups Session II

11:45 AM – 1:30 AM Acorn Ballroom AB

Working Lunch

Interpersonal Violence Across the Life Course

Interpersonal Violence Content Expert Working Groups on Communities of Practice / Vulnerable Populations: Homeless Persons, LGBTq Populations, & Migrant Farm Workers

A Marketplace of Ideas

1:30 PM – 2:30 PM Acorn Ballroom AB

NCMEDR Presentation & Discussion of Year 3 Projects

2:30 PM – 3:00 PM Acorn Ballroom AB

Closing Session

Communities of Practice: Lessons Learned & Pathway Forward

OPENING SESSION

Medical Education and Clinical Transformation: A Curriculum Pathway Forward Thursday, May 31, 2018 • 9:00 AM – 11:30 AM

DESCRIPTION A brief discussion that details the anatomy of the Center, its purpose, activities, and expected outcomes using research, dissemination, and communities of practice. Welcome & Overview

Patricia Matthews-Juarez, PhD Meharry Medical College

Year 2 Activities & Products

Paul D. Juarez, PhD Meharry Medical College

Dissemination Strategies

Wansoo Im, PhD Meharry Medical College

Social Media Tools

Katherine Y. Brown, EdD, OTR/L Meharry Medical College

Program Agenda

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INSTITUTIONAL GREETINGS & LUNCH

Medical Education Curriculum Transformation Thursday, May 31, 2018 • 11:30 AM – 2:00 PM

PURPOSE This session will acquaint members of the community of practice with the national and local medical education landscape and provide an overview of common principles underlying current and future work of the Center around research needed to promote health equity among vulnerable populations.

OBJECTIVES »» Discuss how to gain the commitment of the leadership of the medical schools across the nation in support of transforming clinical practice through curriculum transformation. »» Discuss how the Center faculty and staff will work together to identify and recommend innovative primary care education, training, and clinical practice approaches and tools that address health concerns of vulnerable populations in the United States. »» Present and discuss Center studies and methodologies used for Year 2 projects. »» Discuss how to engage core content experts to guide COP efforts over the next three (3) years. »» Explore and implement dissemination tools that will assist medical schools in moving medical education in primary care to transformation, while promoting changes in clinical practice. Greetings

James E.K. Hildreth, PhD, MD Meharry Medical College

Greetings

Veronica Mallett, MD, MMM Meharry Medical College

Greetings

Millard Collins, MD Meharry Medical College

Classroom Environment: How to Manage Clinical Transformation from an Educational Perspective Keynote Speaker Introduction

Mindi Spencer, PhD University of South Carolina

Paul D. Juarez, PhD Meharry Medical College

Keynote Presentation Adverse Childhood Experiences and their Impact on Health

Altha Stewart, MD

Questions & Answers

Altha Stewart, MD

University of Tennessee Health Science Center University of Tennessee Health Science Center

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Program Agenda

WORKING GROUPS SESSION I

Communities of Practice ACEs Working Groups: Homeless Persons, LGBTq, & Migrant Farm Workers Thursday, May 31, 2018 • 2:00 PM – 4:30 PM

DESCRIPTION Discuss ACEs as they pertain to vulnerable populations and identify curricular strategies for teaching medical students how to address the topic. ACEs Working Group Instructions

Katherine Y. Brown, EdD, OTR/L Meharry Medical College

Homeless Persons

Beth Shinn, PhD, Facilitator Vanderbilt University

LGBTq Persons

Leandro Mena, MD, MPH, Facilitator University of Mississippi Medical Center

Migrant Farm Workers

Thomas A. Arcury, PhD, Facilitator Wake Forest University

Re-convene, Discussion, & Recap

Paul D. Juarez, PhD Meharry Medical College

CoP Recommendations from the Groups

Katherine Y. Brown, EdD, OTR/L Meharry Medical College

Program Agenda

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RECEPTION

Group Interactive Reception by Communities of Practice Thursday, May 31, 2018 • 5:00 PM – 7:00 PM

DESCRIPTION Engage in small group interactions with medical students and community healthcare professionals about ACEs and Interpersonal Violence across the life course.

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Program Agenda

KEYNOTE PRESENTATION

Interpersonal Violence by Communities of Practice Friday, June 1, 2018 • 7:55 AM – 8:50 AM

DESCRIPTION Dr. Christopher Layne will discuss interpersonal violence across the life course and identify curricular strategies for teaching medical students how to address the topic. Opening Remarks

Patricia Matthews-Juarez, PhD Meharry Medical College

Keynote Speaker Introduction

Paul D. Juarez, PhD Meharry Medical College

Keynote Presentation Interpersonal Violence across the Life Course

Christopher M. Layne, PhD

Questions & Answers

Christopher M. Layne, PhD

University of California, Los Angeles University of California, Los Angeles

Program Agenda

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WORKING GROUP SESSION II

Interpersonal Violence Content Expert Working Groups on Communities of Practice / Vulnerable Populations: Homeless Persons, LGBTq Populations, & Migrant Farm Workers Friday, June 1, 2018 • 8:50 AM – 11:45 AM

DESCRIPTION Discuss Interpersonal Violence across the life course as it pertains to vulnerable populations, and identify curricular strategies for teaching medical students how to address the topic. IV Working Group Instructions

Katherine Y. Brown, EdD, OTR/L Meharry Medical College

Homeless Persons

Beth Shinn, PhD, Facilitator Vanderbilt University

LGBTq Persons

Leandro Mena, MD, MPH, Facilitator University of Mississippi Medical Center

Migrant Farm Workers

Thomas A. Arcury, PhD, Facilitator Wake Forest University

Re-convene, Discussion, & Recap

Paul D. Juarez, PhD Meharry Medical College

CoP Recommendations from the Groups

Katherine Y. Brown, EdD, OTR/L Meharry Medical College

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Program Agenda

WORKING LUNCH

A Marketplace of Ideas Friday, June 1, 2018 • 11:45 AM – 1:30 PM

DESCRIPTION Discuss effective tools for training a new cadre of health professionals in patient-centeredness and vulnerable populations. Videos & Research Products

NCMEDR Faculty Meharry Medical College

Program Agenda

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NCMEDR PRESENTATION & DISCUSSION

Year 3 Projects: Immunization Disparities & Opioid Misuse Friday, June 1, 2018 • 1:30 PM – 2:30 PM

DESCRIPTION Using round-table discussions, examine the implications for broad impact in medical education in primary care and clinical transformation. Opening Remarks

Paul D. Juarez, PhD Meharry Medical College

Immunization Disparities

Thomas A. Arcury, PhD, Facilitator Wake Forest University

Opioid Misuse

Robert L. Cooper, PhD, Facilitator Meharry Medical College

Feedback, Questions & Answers

Paul D. Juarez, PhD Meharry Medical College

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Program Agenda

CLOSING SESSION

Communities of Practice: Lessons Learned & Pathway Forward Friday, June 1, 2018 • 2:30 PM – 3:00 PM

DESCRIPTION Discuss the implementation of curriculum and clinical transformation. Communities of Practice: Lessons Learned & Pathway Forward

Patricia Matthews-Juarez, PhD Meharry Medical College

Program Agenda

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CONFERENCE FACULTY, COMMUNITY PARTNERS, & STAFF Donald J. Alcendor, PhD

Associate Professor MIcrobiology & Immunology & Physiology/CAHDR Meharry Medical College Nashville, Tennessee

Monique Anthony, MPH, CHES

Director Office of Minority Health and Disparities Elimination Tennessee Department of Health Nashville, Tennessee

Thomas A. Arcury, PhD †

Meharry Medical College Nashville, Tennessee

Darlene Jenkins, DrPH

National Health Care for the Homeless Council Nashville, Tennessee

Christopher G Johnson, II, BS, MHS, MD Meharry Medical College Nashville, Tennessee

Warren Jones, MD

Professor Family and Community Medicine Wake Forest University Winston-Salem, North Carolina

Chief Health Officer Hampton University Ridgeland, Mississippi

Claudia Baquet, MD, PhD, MPH

Professor & Vice Chair, Research Meharry Medical College Nashville, Tennessee

President / Clinical Professor Hope Institute, LLC University of Maryland Columbia, Maryland

Darren E. Baylor 1Joshua Group, LLC Atlanta, Georgia

Paul D. Juarez, PhD *

CoCo Kelly

Trans Community Advocate Mashup! Nashville Nashville, Tennessee

Kenneth H. Kraybill, MSW

Allyson Belton, MPH

Morehouse School of Medicine Atlanta, Georgia

Katherine Y. Brown, EdD, OTR/L * Director Communities of Practice Meharry Medical College Nashville, Tennessee

Director of Training t3 (think. teach. transform.) Center of Social Innovation Seattle, Washington

Christopher M. Layne, PhD

Director of Education in Evidence-Based Practice Research Psychologist Psychiatry and Biobehavioral Sciences University of California, Los Angeles Duke University Los Angeles, California

Kimberly L. Brown Project Associate 1Joshua Group, LLC Atlanta, Georgia

Justin A. Lofton

Kristen N. Campbell, BS Project Associate 1Joshua Group, LLC Atlanta, Georgia

Founder My House Nashville,Precision Creative Solutions Antioch, Tennessee

Brian I. Marshall

Linda A. Clayton, MD, MPH

Medical Director Women’s and Reproductive Health Division of Family Health and Wellness Tennessee Department of Health Nashville, Tennessee

Robert L. Cooper, PhD *

Mashup! Nashville Nashville, Tennessee

Patricia Matthews-Juarez, PhD *

Vice President Office of Faculty Affairs and Development Meharry Medical College Nashville, Tennessee

Assistant Professor Family and Community Medicine Meharry Medical College Nashville, Tennessee

Leandro Mena, MD, MPH †

Jateria R. Davis

Matthew Morris, PhD *

Associate Professor of Medicine University of Mississippi Medical Center Jackson, Mississippi

Medical Student Meharry Medical College Nashville, Tennessee

Meharry Medical College Nashville, Tennessee

Cheryl L. Holder, MD

Executive Associate Faculty Affairs & Development Meharry Medical College Nashville, Tennessee

Christian Neal

Associate Professor Humanities Health and Society Florida International University Miami, Florida

Sharon Hurt, MEd

* NCMEDR Faculty |

Freida H. Outlaw, PhD, RN, APPN, FAAN

Executive Program Academic Consultant Substance Abuse and Mental Health Services Administration Nashville, Tennessee

Executive Director StreetWorks, Inc. Nashville, Tennessee

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Wansoo Im, PhD *

†

NCMEDR Consultants

Deborah Padgett, PhD

NYU Silver School of Social Work New York, New York

Michael Paul, MPH

Meharry Medical College Nashville, Tennessee

Kermit G. Payne, BFA President and CEO 1Joshua Group, LLC Atlanta, Georgia

Professor Biostatistics, Graduate Studies and Research Meharry Medical College Nashville, Tennessee

Zuay Thompson, MBA Meharry Medical College Nashville, Tennessee

Lesia D. Walker, MPH, BS MT

Elvin T. Price, PharmD, PhD

Associate Professor Pharmacotherapy & Outcomes Science Virginia Commonwealth University Richmond, Virginia

Aramandla Ramesh, PhD * Meharry Medical College Nashville, Tennessee

Linda C. Redd, MHSA, MBA

Program Director Office of Faculty Affairs and Development Meharry Medical College Nashville, Tennessee

James C. Roberson, III, MHS Student School of Medicine Meharry Medical College Nashville, Tennessee

Edwin C. Sanders, II

Senior Servant Metropolitan Interdenominational Church Nashville, Tennessee

Daniel F.K. Sarpong, PhD

Director & Endowed Chair, Professor of Biostatistics College of Pharmacy Xavier University of Louisiana New Orleans, Louisiana

Beth Shinn, PhD

Mohammad A. Tabatabai, PhD *

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Cornelius Vanderbilt Professor Human and Organizational Development Vanderbilt University Nashville, Tennessee

Juliana Simmons, MSPH, CHES Program Manager Migrant Clinicians Network Bel Air, Maryland

Mindi Spencer, PhD

University of South Carolina Columbia, South Carolina

Program Coordinator TN Area Health Education Center Meharry Medical College Nashville, Tennessee

Jazmyn Walls

Trans Community Advocate Mashup! Nashville Nashville, Tennessee

Rueben C. Warren, DDS, MPH, DrPH, MDiv

Professor of Bioethics and Director National Center For Bioethics In Research and Health Care Tuskegee University Tuskegee, Alabama

T. Alex Washington, PhD, MSSW, MA Professor and Behavioral Research Scientist School of Social Work California State University, Long Beach Long Beach, California

Julia Watson, MSPH

Meharry Medical College Nashville, Tennessee

Shelia J. Webb, PhD, APRN, CNS Associate Clinical Director/COO Administration EXCELth, Inc. New Orleans, Louisiana

Suzanne Wenzel, PhD

University of Southern California Los Angeles, California

Foster Williams, Jr., MPA, CHAP Social Worker/Case Manager Family and Community Medicine Meharry Medical College Nashville, Tennessee

Tiffinie A. Zellars, MSN, MSPH, RN RN, Nurse Educator/CQI Nurse Family & Community Medicine Meharry Medical College Nashville, Tennessee

Natalie R. Stevenson, BBA

Program Manager Faculty Affairs and Development Meharry Medical College Nashville, Tennessee

Altha Stewart, MD

Associate Professor Psychiatry University of TN Health Science Center Memphis, Tennessee

* NCMEDR Faculty |

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NCMEDR Consultants

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YEAR 2 RESEARCH PROJECT

Project 3: Screening & Health Care Services for Vulnerable Populations Exposed to Interpersonal Violence across the Life Course

DESCRIPTION This research project will assess the extent to which medical schools prepare students to address the needs of vulnerable populations exposed to interpersonal violence across the life course in primary care settings. It will employ multiple methods to assess current medical school educational practice, identify evidence-based best practices, develop and recommend curricular modifications, and disseminate information to the broader medical education profession through presentations at professional meetings, policy briefs, and articles in peer reviewed journals. Statement of the problem gaps in current research: Interpersonal violence (IV) is “the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, stunted emotional development, or deprivation. IV occurs across the life course and threatens the life, health and happiness of thousands of persons each year in the United States. IV encompasses a wide range of incidents from child abuse and neglect by caregivers, youth violence (violence by adolescents and young adults aged 10 to 29 years), intimate partner violence, sexual violence, elder abuse, and gun violence. There is a limited evidence base regarding best strategies in teaching medical students how to screen for and address the needs of vulnerable populations affected by interpersonal violence. It is important that medical students understand and are prepared to take steps to address underlying individual, interpersonal, community and societal-level factors that increase the risk for interpersonal violence across the life course among of vulnerable populations. This research project will assess the extent to which medical students are taught about the needs of vulnerable populations and the skills to screen, care, and refer those exposed to interpersonal violence across the life course in primary care.

RESEARCH QUESTIONS »» What is the evidence base regarding education of medical students on screening for interpersonal violence across the life course among vulnerable populations for medical students in primary care settings? »» What are the core elements of the medical educational curriculum that can be revised and adapted to ensure students have the knowledge and skills to provide culturally competent health care for vulnerable populations exposed to interpersonal violence across the life course?

PROJECT GOALS »» To identify the extent to which medical students are trained to screen, treat, or refer persons exposed to interpersonal violence across the life course. »» To develop model curricular elements that can be used by other medical schools to prepare students to effectively address the needs of vulnerable populations exposed to violence at different stages of life. »» To disseminate research results on how medical schools are addressing exposure to interpersonal violence across the life course in vulnerable populations to graduate medical education audiences.

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NCMEDR Projects

YEAR 2 RESEARCH PROJECT

Project 4: Screening and Health Care Services for Adverse Childhood Experiences in Vulnerable Populations in Primary Care Settings

DESCRIPTION The aim of this research is to identify and assess the extent to which medical students are taught about adverse childhood experiences (ACEs): screening, treatment, community referrals and their impact on personal health and health disparities in primary care settings. Based on this aim, we pose several research questions to be answered through systematic review of the literature, curricula, and student surveys about how medical schools are preparing students to address the effects of ACEs, with a focus on vulnerable populations. We will disseminate findings through scholarly presentations at graduate medical education conferences and meetings, peer reviewed publications, our community of practice, and a policy brief and provide technical assistance to programs on how to incorporate ACES in their curriculum and respond to the needs of vulnerable populations. Statement of the problem gaps in current research: Increasingly, studies are showing that adverse childhood experiences (ACEs) affect the health f persons as they age. Yet, there is paucity of information in the literature regarding strategies to teach medical students how to screen for ACEs and be responsive to the needs of vulnerable populations that are impacted by ACEs. While there is a growing body of research that supports a dose-response relationship between number of ACEs experienced during childhood and a range of adverse health outcomes of adulthood, especially among vulnerable populations, relatively little is known about the extent to which medical students are being taught about the effects of ACEs on the health of vulnerable populations, including LGBTq populations, homeless persons and, migrant farm workers, and how to screen for and care for those who have multiple exposures. To date, little systematic attention has been given to ensuring future primary health care providers are trained to screen for ACEs, undertake interventions that can improve long term health outcomes later in life, or refer patients to community resources that can lead improvements in health and healthcare.

RESEARCH QUESTIONS »» What evidence exists regarding what and how medical students are being taught about ACEs: what they are, what impact they have later in life, how they affect vulnerable populations, and what skills they are being taught to help students address them? »» What are the core elements of the medical educational curriculum that can be revised and adapted to ensure students have the knowledge and skills to provide culturally competent health care for vulnerable populations exposed to ACEs?

PROJECT GOALS »» To identify the extent to which medical students are trained to screen, treat, or refer persons exposed to ACEs in primary care settings. »» To identify and/or develop model curricular elements that can be used by other medical schools to prepare students to effectively address the needs of vulnerable populations exposed to ACEs. »» To disseminate research results and curricular modules on how medical schools are addressing ACEs in vulnerable populations to graduate medical education audiences.

OBJECTIVES »» Provide direct feedback and consensus from content experts on the adequacy of the primary care research training process using evidence-based studies, data, and methodologies. »» Determine the effectiveness and efficacy of the studies, results, findings, and products to inform curricular change in medical education in treating vulnerable populations that focus on continuing quality of care, team building and value-based pricing.

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Project 5: Childhood and Adult Immunization Disparities

AUTHORS Aramandla Ramesh, Ph.D., Paul Juarez, Ph.D., Matthew Morris, Ph.D., R. Lyle Cooper, Ph.D., MSSW, Mohammad Tabatabai, Ph.D. Thomas A. Arcury, Ph.D., Beth Shinn, PhD, Leandro Mena, M.D., M.P.H., and Patricia Mathews-Juarez, Ph.D.

BACKGROUND Vaccines reduce a persons risk of infection by working with their body’s natural defenses to help them safely develop immunity to disease. Vaccines help develop immunity by imitating an infection, but this “imitation” infection does not cause illness. Instead it causes the immune system to develop the same response as it does to a real infection so the body can recognize and fight the vaccine-preventable disease in the future. The Advisory Committee on Immunization Practices (ACIP) is a group of medical and public health experts that develops recommendations on how to use vaccines to control diseases in the United States. The ACIP has designed a vaccination schedule to protect young children, teens, and adults before they are likely to be exposed to potentially serious diseases and when they are most vulnerable to serious infections. For children birth to 6 years of age, the vaccine schedule includes chickenpox, diphtheria, flu, hepatitis A, Hepatitis B, Hib, measles, mumps, polio, pneumococcal, rotavirus, rubella, tetanus, and whopping cough. For children and teens, 7 through 18 years of age, the CDC recommends vaccines for flu, HPV, meningococcal, and TDAP. For adults 19-64, the National Center for Immunization and Respiratory Diseases recommends a schedule of vaccines for influenza (annually), Tdap, MMR, VAR, RZV, HPV, PCV13, PPSV23, HepA, HepB, MenACWY, MenB, and Hib. For persons over 65, the CDC also recommends vaccines for influenza, MMR, RZV, PCV13, HPV, PCV13, and PPSV23. Millions of Americans experience difficulties obtaining culturally competent, primary care due to cost, social and economic tradeoffs, and lack of accessibility. Unique circumstances and exposures encountered by persons who are LGBTq, homeless, and/or migrant farmworkers may decrease their likelihood of completing the schedule of childhood and adult vaccines, increasing their risk of infectious disease and of infecting others. Disparities in health care access and quality create barriers for vulnerable populations that increase risk for adverse health outcomes.

PURPOSE Homeless persons, LGBTq populations, and migrant farm workers are at higher risk for morbidity and mortality from both chronic and episodic illness than the general population. Few data are available on the prevalence of these conditions and uptake of vaccination for prevention. The unique conditions and circumstances encountered by these vulnerable populations can serve as obstacles to completing the recommended childhood and adult vaccination schedules, exposing them, and people they come into contact with increased risk for contracting infectious, yet preventable diseases. The purpose of this study is to identify whether and/or how medical students are being taught to recognize and address the challenges encountered by vulnerable populations in completing the schedule of childhood and adult immunizations.

METHODS We will conduct a systematic review literature using the PRISMA 2009 Checklist to identify how medical students and health care providers are being taught to recognize and respond to the unique immunization needs of LGBTq and homeless and migrant farm workers. The purpose of this review is to identify how medical schools are training students to address the immunization needs of vulnerable populations. In addition, we will work with our Community of Practice to develop and conduct a survey of the three vulnerable populations as to how their health care providers have addressed their immunization needs.

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REFERENCES Aldridge, R. W., Hayward, A. C., Hemming, S., Yates, S. K., Ferenando, G., Possas, L., . . . Story, A. (2018). High prevalence of latent tuberculosis and bloodborne virus infection in a homeless population. Thorax, 73(6), 557.

Jones, J., Poole, A., Lasley-Bibbs, V., & Johnson, M. (2016). LGBT health and vaccinations: Findings from a community health survey of Lexington-Fayette County, Kentucky, USA. Vaccine, 34(16), 1909-1914. doi:https://doi.org/10.1016/j.vaccine.2016.02.054

Alexander, A. B., Best, C., Stupiansky, N., & Zimet, G. D. (2015). A model of health care provider decision making about HPV vaccination in adolescent males. Vaccine, 33(33), 4081-4086. doi:https://doi. org/10.1016/j.vaccine.2015.06.085

Kaplan-Weisman, L., Waltermaurer, E., & Crump, C. (2018). Assessing and Improving Zoster Vaccine Uptake in a Homeless Population. Journal of community health. doi:10.1007/s10900-018-0517-x

Bednarczyk, R. A., Whitehead, J. L., & Stephenson, R. (2017). Moving beyond sex: Assessing the impact of gender identity on human papillomavirus vaccine recommendations and uptake among a national sample of rural-residing LGBT young adults. Papillomavirus Research, 3, 121-125. doi:https://doi.org/10.1016/j.pvr.2017.04.002 Beijer, U., Wolf, A., & Fazel, S. (2012). Prevalence of tuberculosis, hepatitis C virus, and HIV in homeless people: a systematic review and meta-analysis. The Lancet infectious diseases, 12(11), 859-870. doi:10.1016/S1473-3099(12)70177-9 Cahill S1, Makadon H3,4. (2014). Sexual Orientation and Gender Identity Data Collection in Clinical Settings and in Electronic Health Records: A Key to Ending LGBT Health Disparities. LGBT Health., 1(1), 34-41. Cassone, A. (2012). Prevalence of tuberculosis, hepatitis C virus, and HIV in homeless people: a systematic review and meta-analysis. Pathogens and Global Health, 106(7), 377-377. doi:10.1179/204777241 2Z.00000000086 Fierman, A. H., Dreyer, B. P., Acker, P. J., & Legano, L. (1993). Status of Immunization and Iron Nutrition in New York City Homeless Children. Clinical Pediatrics, 32(3), 151-155. doi:10.1177/000992289303200305

Kemsley, M., & Riegle, E. A. (2004). A Community-campus Partnership: Influenza Prevention Campaign. Nurse Educator, 29(3), 126-129. Lee, C. V., McDermott, S. W., & Elliott, C. (1990). The delayed immunization of children of migrant farm workers in South Carolina. Public Health Reports, 105(3), 317-320. McRee, A.-L., Katz, M. L., Paskett, E. D., & Reiter, P. L. (2014). HPV vaccination among lesbian and bisexual women: Findings from a national survey of young adults. Vaccine, 32(37), 4736-4742. doi:https://doi.org/10.1016/j.vaccine.2014.07.001 Schoch-Spana M1, B. N., Rambhia KJ, Norwood A. (2010). Stigma, health disparities, and the 2009 H1N1 influenza pandemic: how to protect Latino farmworkers in future health emergencies. Biosecur Bioterror., 8(3), 243-254. Steege, A. L., Baron, S., Davis, S., Torres-Kilgore, J., & Sweeney, M. H. (2009). Pandemic Influenza and Farmworkers: The Effects of Employment, Social, and Economic Factors. American Journal of Public Health, 99(Suppl 2), S308-S315. doi:10.2105/AJPH.2009.161091 Young, S., Dosani, N., Whisler, A., & Hwang, S. (2014). Influenza Vaccination Rates Among Homeless Adults With Mental Illness in Toronto. Journal of Primary Care & Community Health, 6(3), 211-214. doi:10.1177/2150131914558881

Fontenot, H. B., Lee-St. John, T., Vetters, R., Funk, D., Grasso, C., & Mayer, K. H. (2016). The Association of Health Seeking Behaviors With Human Papillomavirus Vaccination Status Among High-Risk Urban Youth. Sexually Transmitted Diseases, 43(12), 771-777. doi:10.1097/ olq.0000000000000521 Gray, G. C., & Kayali, G. (2009). Facing pandemic influenza threats: The importance of including poultry and swine workers in preparedness plans1. Poultry Science, 88(4), 880-884. doi:10.3382/ps.2008-00335 Hurley, L. P., Bridges, C. B., Harpaz, R., Allison, M. A., O’Leary, S. T., Crane, L. A., . . . Kempe, A. (2014). U.S. Physicians’ Perspective of Adult Vaccine Delivery. Annals of Internal Medicine, 160(3), 161-161. doi:10.7326/M13-2332 Hurley, L. P., Lindley, M. C., Allison, M. A., Crane, L. A., Brtnikova, M., Beaty, B. L., . . . Kempe, A. (2017). Financial Issues and Adult Immunization: Medicare Coverage and the Affordable Care Act. Vaccine, 35(4), 647-654. doi:10.1016/j.vaccine.2016.12.007 Hurley, L. P., Lindley, M. C., Harpaz, R., & et al. (2010). BArriers to the use of herpes zoster vaccine. Annals of Internal Medicine, 152(9), 555560. doi:10.7326/0003-4819-152-9-201005040-00005 Hutchins, S. S., Truman, B. I., Merlin, T. L., & Redd, S. C. (2009). Protecting Vulnerable Populations From Pandemic Influenza in the United States: A Strategic Imperative. American Journal of Public Health, 99(Suppl 2), S243-S248. doi:10.2105/AJPH.2009.164814

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PROPOSED YEAR 3 RESEARCH PROJECT

Project 6: Opioid Misuse

AUTHORS R. Lyle Cooper, Ph.D., MSSW, Paul Juarez, Ph.D., Matthew Morris, Ph.D. Aramandla Ramesh, Ph.D., Mohammad Tabatabai, Ph.D. Thomas A. Arcury, Ph.D., Leandro Mena, M.D., M.P.H., and Patricia Mathews-Juarez, Ph.D.

BACKGROUND The opioid crisis has worsened in recent years. In 2011, more than 366,000 people were treated in emergency departments for misusing prescription opioids – an over two-fold increase since 2005. In 2014, almost 2 million Americans abused or were dependent on prescription opioids. Additionally, as many as 25% of people who receive prescription opioids for non-cancer pain in primary care settings struggle with addiction. The potential for fatal overdose distinguishes opioids from other drugs. In 2015, more than 33,000 deaths were attributed to opioid overdose. More than 60% of drug overdoses involve opioids and nearly half of all opioid deaths are due to prescriptions. The recent surge in illicit opioid overdoses also has been driven by heroin and illegally-made drugs, such as fentanyl. The face of the opioid epidemic also is evolving. While the epidemic started in rural America, data from the 2015 National Survey on Drug Use and Health show that opioid misuse and addiction are now as prevalent in urban and suburban areas. A recent U.S. Department of Health and Human Services (HHS) study found that the proportion of the population using prescription opioids is similar across large metropolitan (36.0%), small metropolitan (40.1%), and non-metropolitan (39.9%) areas. Overdose is also a leading cause of death for individuals returning to the community from prison, who disproportionately are African Americans and Latinos. American Indian/Alaska Native populations also have been disproportionately impacted compared to other communities (e.g., in terms of heroin use).

PURPOSE The efforts to address the opioid crisis reveal some common needs across all communities in general, and vulnerable populations specifically, including persons who are LGBTq, homeless, and/or migrant farmworkers. Discrimination, implicit bias, lack of access to care and other social factors create unique challenges that both increase risk for opioid use and misuse and barriers to treatment. Our capacity to respond to the opioid epidemic is largely dependent upon capacity of the health care system to provide a spectrum of opioid services, from prevention to medically assisted treatment. Little is known about how medical schools are preparing future physicians to address this crisis. Even less is known about how they are preparing students to address the unique needs of vulnerable populations.

METHODS We will conduct a systematic review literature using the PRISMA 2009 Checklist to identify how medical students and healthcare providers are being taught to screen for and respond to opioid use in general, and the needs of LGBTq populations, homeless persons, and migrant farm workers, in particular. In addition, we will work with our Community of Practice to develop and conduct a survey of the three vulnerable populations as to how their health care providers have addressed the opioid crisis with them or their family members.

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REFERENCES HOMELESS

MIGRANT FARMWORKERS

A. Bachhuber, M. D. M. M., Christopher B. Roberts, M. P. H., Metraux, S., & Montgomery, A. (2015). Screening for homelessness among individuals initiating medication-assisted treatment for opioid use disorder in the Veterans Health Administration (Vol. 11).

Borges, G., Cherpitel, C. J., Orozco, R., Zemore, S. E., Wallisch, L., Medina-Mora, M.-E., & Breslau, J. (2016). Substance Use and Cumulative Exposure to American Society: Findings From Both Sides of the US–Mexico Border Region. American Journal of Public Health, 106(1), 119-127. doi:10.2105/AJPH.2015.302871

Cherpitel, C. J., Ye, Y., Zemore, S. E., Bond, J., & Borges, G. (2015). THE EFFECT OF CROSS-BORDER MOBILITY ON ALCOHOL AND DRUG USE AMONG MEXICAN-AMERICAN RESIDENTS LIVING AT THE U.S–MEXICO BORDER. Addict Behav, 50, 28-33. doi:10.1016/j. addbeh.2015.06.008 Cheung, A., Somers, J. M., Moniruzzaman, A., Patterson, M., Frankish, C. J., Krausz, M., & Palepu, A. (2015). Emergency department use and hospitalizations among homeless adults with substance dependence and mental disorders. Addiction Science & Clinical Practice, 10, 17. doi:10.1186/s13722-015-0038-1 Hall, G., Walters, S., Gould, H., & Lim, S. (2018). Housing versus treatment first for supportive housing participants with substance use disorders: A comparison of housing and public service use outcomes. Substance Abuse, 1-7. doi:10.1080/08897077.2018.1449049 Kerman, N., Sylvestre, J., Aubry, T., & Distasio, J. (2018). The effects of housing stability on service use among homeless adults with mental illness in a randomized controlled trial of housing first. BMC Health Services Research, 18, 190. doi:10.1186/s12913-018-3028-7 Palepu, A., Gadermann, A., Hubley, A. M., Farrell, S., Gogosis, E., Aubry, T., & Hwang, S. W. (2013). Substance Use and Access to Health Care and Addiction Treatment among Homeless and Vulnerably Housed Persons in Three Canadian Cities. PLoS ONE, 8(10), e75133. doi:10.1371/journal.pone.0075133 Parpouchi, M., Moniruzzaman, A., Rezansoff, S. N., Russolillo, A., & Somers, J. M. (2017). Characteristics of adherence to methadone maintenance treatment over a 15-year period among homeless adults experiencing mental illness. Addictive Behaviors Reports, 6, 106-111. doi:10.1016/j.abrep.2017.09.001

LGBTQ Buttram, M. E., Kurtz, S. P., Surratt, H. L., & Levi-Minzi, M. A. (2014). Health and Social Problems Associated with Prescription Opioid Misuse Among a Diverse Sample of High Risk Substance-Using MSM. Substance Use & Misuse, 49(3), 277-284. doi:10.3109/10826084.2013. 828754

Garcia, V. (2007). Meeting a Binational Research Challenge: Substance Abuse Among Transnational Mexican Farmworkers in the United States. The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association, 23(Suppl), 61-67. doi:10.1111/j.1748-0361.2007.00125.x Robertson, A. M., Lozada, R., Pollini, R. A., Rangel, G., & Ojeda, V. D. (2012). Correlates and contexts of U.S. injection drug initiation among undocumented Mexican migrant men who were deported from the United States. AIDS and Behavior, 16(6), 1670-1680. doi:10.1007/s10461-011-0111-z Rosales, C., Ortega, M. I., De Zapien, J. G., Paniagua, A. D. C., Zapien, A., Ingram, M., & Aranda, P. (2012). The US/Mexico Border: A Binational Approach to Framing Challenges and Constructing Solutions for Improving Farmworkers’ Lives. International Journal of Environmental Research and Public Health, 9(6), 2159-2174. doi:10.3390/ijerph9062159 Zhang, X., Martinez-Donate, A. P., Nobles, J., Hovell, M. F., Rangel, M. G., & Rhoads, N. M. (2015). Substance Use Across Different Phases Of The Migration Process: A Survey Of Mexican Migrants Flows. Journal of immigrant and minority health / Center for Minority Public Health, 17(6), 1746-1757. doi:10.1007/s10903-014-0109-5

MEDICAL EDUCATION Korthuis, P., McCarty, D., Weimer, M., & et al. (2017). Primary care– based models for the treatment of opioid use disorder: A scoping review. Annals of Internal Medicine, 166(4), 268-278. doi:10.7326/ M16-2149 Zule, W. A., Oramasionwu, C., Evon, D., Hino, S., Doherty, I. A., Bobashev, G. V., & Wechsberg, W. M. (2016). Event-level analyses of sex risk and injection risk behaviors among nonmedical prescription opioid users. The American journal of drug and alcohol abuse, 42(6), 689-697. doi:10.1080/00952990.2016.1174706

Corliss, H. L., Rosario, M., Wypij, D., Wylie, S. A., Frazier, A. L., & Austin, S. B. (2010). Sexual Orientation and Drug Use in a Longitudinal Cohort Study of U.S. Adolescents. Addict Behav, 35(5), 517-521. doi:10.1016/j.addbeh.2009.12.019 Li, D. H., & Mustanski, B. (2018). Prevalence and Correlates of Prescription Drug Misuse Among a Racially Diverse Sample of Young Sexual Minority Men. LGBT Health, 5(2), 95-104. doi:10.1089/ lgbt.2017.0125

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PROPOSED YEAR 3 RESEARCH PROJECT

Project 7: Leveraging the Affordable Care Act to Address Needs of Homeless Populations

AUTHORS Paul Juarez, Ph.D., Aramandla Ramesh, Ph.D., Matthew Morris, Ph.D., R. Lyle Cooper, Ph.D., MSSW, Mohammad Tabatabai, Ph.D. Thomas A. Arcury, Ph.D., Beth Shinn, PhD, Leandro Mena, M.D., M.P.H., and Patricia Mathews-Juarez, Ph.D.

BACKGROUND Estimates are that there are approximately 630,000 people who are homeless on any given night in the U.S. — about two-thirds in shelters and one-third on the street or without real shelter. Several million people are estimated to experience homelessness over the course of a year. About two-thirds are individuals and the balance are in families. Many people experiencing homelessness have complex health challenges that both contribute to, and are exacerbated by, homelessness. These include behavioral health challenges like mental health or substance use disorders, as well as medical conditions like diabetes, HIV/AIDS, liver disease, and hypertension. They generally have limited access to health care because they are often unemployed, lacking employer-sponsored insurance, and living in poverty. As a result, many people experiencing homelessness have had to rely on emergency room visits and uncompensated hospital care, resulting in poor health outcomes, higher mortality risks, and higher public costs. The Affordable Care Act was signed into law in 2010 to provide all Americans with access to qualify health care, along with insurance that is both attainable and affordable. The Affordable Care Act benefits people experiencing homelessness in three ways: 1) It makes health insurance more accessible and affordable — both through affordable private insurance and expanded Medicaid eligibility — giving people greater protection from financial vulnerability that can lead to homelessness. 2) It ensures coverage of the kind of health care services that can help support people as they exit homelessness including behavioral health care, rehabilitative services, and tenancy supports. 3) It shifts the focus of health care delivery on outcomes and value — not procedures and volume — putting “whole person” health at the forefront and encouraging partnerships between health care and other needs like housing and social services. Medicaid is the health insurance option for most people experiencing homelessness, given their extremely low-incomes. Before the Affordable Care Act, most people only qualified for Medicaid if they were disabled, pregnant, parents, or children. The Affordable Care Act gives states the option to expand Medicaid coverage to all eligible people whose earnings are less than 133% of the Federal Poverty Level, regardless of their disability or family status. However, the choice to expand Medicaid eligibility is left to states.

PURPOSE Increased access to Medicaid under the ACA provides the opportunity for medical services to be provided to homeless persons who would otherwise remain uncovered. This study seeks to identify what medical students are taught about Medicaid coverage for homeless persons under the ACA.

METHODS We will conduct a systematic literature review using the PRISMA 2009 Checklist to identify how medical students are being taught to screen for and address the health care needs of homeless persons and their knowledge of how to leverage the Affordable Care Act to address those needs. In addition, we propose to conduct a survey of providers at community health centers to identify how familiar they are with the ACA and coverage for health care of homeless persons. This information will be used to make recommendations for training medical students about addressing the health care needs of homeless persons.

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REFERENCES Barry, C. L., Goldman, H. H., & Huskamp, H. A. (2016). Federal Parity In The Evolving Mental Health And Addiction Care Landscape. Health Affairs, 35(6), 1009-1016. doi:10.1377/hlthaff.2015.1653 DiPietro, B., & Klingenmaier, L. (2013). Achieving Public Health Goals Through Medicaid Expansion: Opportunities in Criminal Justice, Homelessness, and Behavioral Health With the Patient Protection and Affordable Care Act. American Journal of Public Health, 103(Suppl 2), e25-e29. doi:10.2105/AJPH.2013.301497 Fryling, L. R., Mazanec, P., & Rodriguez, R. M. (2015). Homeless Persons’ Barriers to Acquiring Health Insurance through the Affordable Care Act. The Journal of Emergency Medicine, 49(5), 755762.e752. doi:10.1016/j.jemermed.2015.06.005 Gonzales G1, H.-S. C. (2017). The Affordable Care Act and Health Insurance Coverage for Lesbian, Gay, and Bisexual Adults: Analysis of the Behavioral Risk Factor Surveillance System. LGBT Health., 4(1), 62-67. Hetrick, M. (2015). Medicaid and Migrant Farmworkers: Why the State Residency Requirement Presents a Significant Access Barrier and What States Should Do About It. Health Matrix Clevel., 25, 437-485. Jones, A. L., Hausmann, L. R. M., Kertesz, S., Suo, Y., Cashy, J. P., Mor, M. K., . . . Gordon, A. J. (9000). Differences in Experiences With Care Between Homeless and Nonhomeless Patients in Veterans Affairs Facilities With Tailored and Nontailored Primary Care Teams. Medical care, Publish Ahead of Print. doi:10.1097/mlr.0000000000000926

Padula, W. V., Heru, S., & Campbell, J. D. (2016). Societal Implications of Health Insurance Coverage for Medically Necessary Services in the U.S. Transgender Population: A Cost-Effectiveness Analysis. Journal of General Internal Medicine, 31(4), 394-401. doi:10.1007/s11606-0153529-6 Socias, C., Liang, Y., Delclos, G., Graves, J., Hendrikson, E., & Cooper, S. (2016). The Feasibility of using Electronic Health Records (EHRs) to describe demographic and clinical indicators of Migrant and Seasonal Farmworkers. J Agromedicine, 21(1), 71-81. doi:10.1080/1059 924X.2015.1074633 Tsai, J., Doran, K. M., & Rosenheck, R. A. (2013). When Health Insurance Is Not a Factor: National Comparison of Homeless and Nonhomeless US Veterans Who Use Veterans Affairs Emergency Departments. American Journal of Public Health, 103(Suppl 2), S225-S231. doi:10.2105/AJPH.2013.301307 Tsai, J., Rosenheck, R. A., Culhane, D. P., & Artiga, S. (2013). Medicaid Expansion: Chronically Homeless Adults Will Need Targeted Enrollment And Access To A Broad Range Of Services. Health Affairs, 32(9), 1552-1559. doi:10.1377/hlthaff.2013.0228 Wen, H., Cummings, J. R., Hockenberry, J. M., Gaydos, L. M., & Druss, B. G. (2013). State Parity Laws and Access to Treatment for Substance Use Disorder in the United States: Implications for Federal Parity Legislation. JAMA Psychiatry, 70(12), 1355-1362. doi:10.1001/ jamapsychiatry.2013.2169

Padula WV1, B. K., 2. (2017). Coverage for Gender-Affirming Care: Making Health Insurance Work for Transgender Americans. LGBT Health, 4(4), 244-247.

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PROPOSED YEAR 3 RESEARCH PROJECT

Project 8: Sexual Violence among Women who are LGBTq, Homeless, or Migrant Farmworkers

AUTHORS Paul Juarez, Ph.D., Aramandla Ramesh, Ph.D., Matthew Morris, Ph.D., R. Lyle Cooper, Ph.D., MSSW, Mohammad Tabatabai, Ph.D. Thomas A. Arcury, Ph.D., Beth Shinn, PhD, Leandro Mena, M.D., M.P.H., and Patricia Mathews-Juarez, Ph.D.

BACKGROUND Women who have sex with women (WSW), homeless, and migrant farmworkers are at increased risk for sexual violence due to their social status in our society. Social conditions experienced by women who have sex with women (WSW) and transgender women, migrant farmworkers, and homeless persons increase risk and/or lead to behaviors that increase risk for sexual violence. These conditions also pose challenges for health and mental health providers. Compared with never WSW, WSW begin sexual activities earlier, engage in sex, and unprotected sex more frequently, and more often trade sex for money or drugs. In combination, these behaviors elevate their risk for violence victimization, as well as for STIs/HIV, tobacco use, alcohol use, heroin, and cocaine, compared to never WSW. These behaviors further increase risk for sexual violence. Among homeless persons, young women who have sex with women (WSW) are at greatest risk for sexual violence. Homeless young women and teens are more likely to engage in survival sex, use drugs, and be in dangerous and vulnerable situations with little or no protection from violent sexual partners. Sexual violence among women within the farmworker community also is a pervasive problem. Ninety percent of female farmworkers in the United States report that workplace sexual violence is a “major problem.� Farmworker women who are victims of sexual violence often suffer in silence. They may have fears of losing their jobs, adverse action by law enforcement including immigration officials, and other forms of retaliation against them or their families. In addition, victims may not know their legal rights. They may have no one to reach out to in an unfamiliar community, isolated by language, distance, culture and lack of transportation.

PURPOSE Sexual violence poses unique risk factors and sequelae for WSW, homeless women, and migrant farm worker women. Each group is vulnerable to sexual violence due to broader social conditions and fears which serve as barriers for them to seek and/or receive care. Perpetrators of sexual violence, frequently use these fears and conditions to exert power and control over their victims. Health care providers may not be aware of the increased risk for sexual violence experienced by these vulnerable populations or having any training on how to screen for and/or address the problem.

METHODS We propose to conduct a systematic review of the literature using the PRISMA 2009 Checklist to identify how medical students are being to screen for sexual violence among WSW, homeless, and migrant farm worker women. The purpose of this review is to identify how medical schools are training students to screen for sexual violence and engage appropriate services and resources to assist them. In addition, we propose to conduct a survey among WSW, homeless, and women migrant farm worker constituents of our CoP partners about whether they have ever been screened for sexual violence by their health care providers and the outcome of the screening. In addition, we will develop curriculum tools which can be used to teach medical students about how to screen for and address sexual violence among WSW, homeless women, and women migrant farm workers.

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REFERENCES Austin, S. B., Jun, H.-J., Jackson, B., Spiegelman, D., Rich-Edwards, J., Corliss, H. L., & Wright, R. J. (2008). Disparities in Child Abuse Victimization in Lesbian, Bisexual, and Heterosexual Women in the Nurses’ Health Study II. J Womens Health (Larchmt), 17(4), 597-606. doi:10.1089/jwh.2007.0450 Bell, A. V., Ompad, D., & Sherman, S. G. (2006). Sexual and Drug Risk Behaviors Among Women Who Have Sex With Women. American Journal of Public Health, 96(6), 1066-1072. doi:10.2105/ AJPH.2004.061077 Broll, R., & Huey, L. (2017). “Every Time I Try to Get Out, I Get Pushed Back”: The Role of Violent Victimization in Women’s Experience of Multiple Episodes of Homelessness. Journal of Interpersonal Violence, 0886260517708405. doi:10.1177/0886260517708405 Dank, M., Lachman, P., Zweig, J. M., & Yahner, J. (2014). Dating Violence Experiences of Lesbian, Gay, Bisexual, and Transgender Youth. Journal of youth and adolescence, 43(5), 846-857. doi:10.1007/ s10964-013-9975-8 Gilmore, A. K., Koo, K. H., Nguyen, H. V., Granato, H. F., Hughes, T. L., & Kaysen, D. L. (2014). Sexual Assault, Drinking Norms, and Drinking Behavior among a National Sample of Lesbian and Bisexual Women. Addict Behav, 39(3), 630-636. doi:10.1016/j.addbeh.2013.11.015 Griner, S. B., Vamos, C. A., Thompson, E. L., Logan, R., VázquezOtero, C., & Daley, E. M. (2017). The Intersection of Gender Identity and Violence: Victimization Experienced by Transgender College Students. Journal of Interpersonal Violence, 0886260517723743. doi:10.1177/0886260517723743 Heerde, J. A., Scholes-Balog, K. E., & Hemphill, S. A. (2015). Associations Between Youth Homelessness, Sexual Offenses, Sexual Victimization, and Sexual Risk Behaviors: A Systematic Literature Review. Archives of sexual behavior, 44(1), 181-212. doi:10.1007/ s10508-014-0375-2 Hequembourg, A. L., Livingston, J. A., & Parks, K. A. (2013). SEXUAL VICTIMIZATION AND ASSOCIATED RISKS AMONG LESBIAN AND BISEXUAL WOMEN. Violence Against Women, 19(5), 634-657. doi:10.1177/1077801213490557

Pyra, M., Weber, K., Wilson, T. E., Cohen, J., Murchison, L., Goparaju, L., & Cohen, M. H. (2014). Sexual Minority Status and Violence Among HIV Infected and At-Risk Women. Journal of General Internal Medicine, 29(8), 1131-1138. doi:10.1007/s11606-014-2832-y Smith, L. R., Yore, J., Triplett, D. P., Urada, L., Nemoto, T., Raj, A., . . . Team, T. S. (2017). Impact of Sexual Violence Across the Lifespan on HIV Risk Behaviors Among Transgender Women and Cisgender People Living With HIV. JAIDS Journal of Acquired Immune Deficiency Syndromes, 75(4), 408-416. doi:10.1097/ qai.0000000000001423 Tsai, A. C., Weiser, S. D., Dilworth, S. E., Shumway, M., & Riley, E. D. (2015). Violent Victimization, Mental Health, and Service Utilization Outcomes in a Cohort of Homeless and Unstably Housed Women Living With or at Risk of Becoming Infected With HIV. American Journal of Epidemiology, 181(10), 817-826. doi:10.1093/aje/kwu350 Tyler, K. A., Whitbeck, L. B., Hoyt, D. R., & Cauce, A. M. (2004). Risk Factors for Sexual Victimization Among Male and Female Homeless and Runaway Youth. Journal of Interpersonal Violence, 19(5), 503520. doi:10.1177/0886260504262961 Wirtz, A. L., Poteat, T. C., Malik, M., & Glass, N. (2018). Gender-Based Violence Against Transgender People in the United States: A Call for Research and Programming. Trauma, Violence, & Abuse, 1524838018757749. doi:10.1177/1524838018757749 Wong, L. H., Shumway, M., Flentje, A., & Riley, E. D. (2016). Multiple types of childhood and adult violence among homeless and unstably housed women in San Francisco. Violence and victims, 31(6), 1171-1182. doi:10.1891/0886-6708.VV-D-15-00132 Young, D. A., Shumway, M., Flentje, A., & Riley, E. D. (2017). The relationship between childhood abuse and violent victimization in homeless and marginally housed women: The role of dissociation as a potential mediator. Psychological Trauma: Theory, Research, Practice, and Policy, 9(5), 613-621. doi:10.1037/tra0000288

Long, S. M., Ullman, S. E., Long, L. M., Mason, G. E., & Starzynski, L. L. (2007). Women’s Experiences of Male-Perpetrated Sexual Assault by Sexual Orientation. Violence and victims, 22(6), 684-701. doi:10.1891/088667007782793138 Lyons, T., Shannon, K., Richardson, L., Simo, A., Wood, E., & Kerr, T. (2016). Women who use drugs and have sex with women in a Canadian setting: Barriers to treatment enrollment and exposure to violence and homelessness. Archives of sexual behavior, 45(6), 14031410. doi:10.1007/s10508-015-0508-2 Mattocks, K. M., Sadler, A., Yano, E. M., Krebs, E. E., Zephyrin, L., Brandt, C., . . . Haskell, S. (2013). Sexual Victimization, Health Status, and VA Healthcare Utilization Among Lesbian and Bisexual OEF/OIF Veterans. Journal of General Internal Medicine, 28(Suppl 2), 604-608. doi:10.1007/s11606-013-2357-9

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AU-PCTE RESEARCH POLICY BRIEF

A Systematic Review of Medical Education Efforts to Reduce Implicit Bias towards LGBTQ Patients

EXECUTIVE SUMMARY BACKGROUND Over the last three decades, there has been a growing recognition that biased attitudes and beliefs of health care providers towards LGBTQ patients in the healthcare system contribute to disparities through its impact on healthcare access and quality of clinical care1,2

METHODS We conducted a systematic review of the literature using the 2009 PRISMA guidelines3 to identify original studies that focused on how medical schools are training students to address implicit bias towards LGBTQ persons. An electronic search was conducted in MEDLINE/PubMed, PsycINFO, Web of Science, Scopus, Ingenta, Science Direct, and Google Scholar databases for articles in English published prior to February 2017.

RESULTS Effective programs designed to increase student or provider knowledge of the LGBTQ community and LGBTQ-relevant health care issues utilized lectures, readings, videos, interviews and presentations by LGBTQ individuals, and group discussion. Significant knowledge gains were observed for students attending single-session4-6 and for students and providers attending more timeintensive program formats7,8. The only study assessing knowledge retention found that knowledge gains for medical students were maintained three months after the training program9. Other programs designed to reduce LGBTQ-related bias in non-providers showed that: 1) educational components can be effective at increasing knowledge about the LGBTQ community; 2) contact with LGBTQ individuals is effective at promoting positive attitudes; 3) the combination of education and intergroup contact is effective at changing attitudes and behavioral intentions; and 4) providing information regarding social norms is effective at changing behavior10.

RECOMMENDATIONS A curricular framework for reducing implicit biases towards LGBTQ persons and other vulnerable populations among medical students is needed and has the potential of transforming medical school education. Bias awareness strategies are more effective when practiced in a supportive and individualized learning environment such as a patient simulation that provides students with opportunities to receive direct feedback out perceived implicit biases while minimizing student defensiveness11.

KEY STAKEHOLDERS Key stakeholders include but are not limited to academic medical institutions, medical education accreditation bodies, health care providers, advocacy groups, public health officials, policymakers, health professions associations, and populations at risk.

ISSUE Research has found that with less time and limited information gathered from the electronic health record (EMR), physician’s behavior becomes increasingly governed by stereotypes and implicit biases12,13. Vulnerable populations, such as LGBTQ individuals often experience higher rates of health disparities, which in part, are driven, by lack of cultural awareness, personal discomfort and/or explicit and implicit bias encountered and exhibited in the health care environment. Little is known about how medical students are trained to identify, confront, and reduce personal bias towards LGBTQ persons and other vulnerable populations. The aim of this study was to conduct a systematic review of how US medical schools are training students to identify and address personal implicit biases towards LGBTQ persons. The research question was shaped by our Community of Practice.

BACKGROUND LGBTQ patients have higher rates of anal cancer14, asthma, cardiovascular disease15-18, obesity16, substance abuse12,18,19, cigarette smoking20, and suicide13. Sexual minority women report fewer lifetime Pap tests21; transgender youth have less access to physical and mental health care22; and LGBTQ individuals are more likely to delay or avoid necessary medical care, compared to heterosexual individuals. These disparities have been attributed, in part, to lower health care utilization by LGBTQ individuals23,24.

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Perceived discrimination from physicians and denial of health care altogether are common experiences among LGBTQ patients and have been identified as contributing to disparities25,26. Implicit biases among health care providers towards LGBTQ persons have been linked to lower quality of care27-29, are rarely assessed30, and can be resistant to change. Previous studies that addressed bias towards patients from racial/ethnic minority groups have found that implicit bias continues to persist despite an absence of negative explicit attitudes31. Even when providers make an explicit commitment to equitable care, implicit biases operating outside of their conscious awareness may undermine that commitment. The disparities in access to care and health outcomes often are compounded by vulnerabilities linked to gender, racial identity32-34 and geographic location35.The percentage of the LGBTQ population lacking a regular primary care provider is significantly higher than among heterosexuals (30% versus 10%, respectively)24,36. One survey of health care providers found that over half expressed discomfort caring for LGBTQ patients37. The importance of physician implicit bias as a contributor to the health disparities that confront LGBTQ individuals is highlighted in professional competency objectives generated by the Association of American Medical Colleges Advisory Committee on Sexual Orientation, Gender Identity, and Sex Development 38. These competencies include the need for understanding that implicit LGBTQ-related bias may negatively impact interactions with patients and for including strategies to mitigate implicit bias in health care settings38. Training medical students to be aware of and address their own implicit biases towards LGBTQ persons and other vulnerable populations provides a critical opportunity for promoting equal access to quality health care and, ultimately, for eliminating health disparities.

METHODS We conducted a systematic review of the literature using the 2009 PRISMA guidelines39 to identify original studies that focused on reducing medical student or health care provider bias towards LGBTQ persons. An electronic search was conducted in MEDLINE/ PubMed, PsycINFO, Web of Science, Scopus, Ingenta, Science Direct, and Google Scholar databases for articles in English published prior to February 2017. The search strategy cross-referenced keywords for LGBTQ populations (lesbian, gay, bisexual, transgender, questioning, homosexual, MSM, WSW, sexual minority) with keywords for health care professions students or providers (medical student, medical resident, provider, physician, doctor, nurse, health personnel, practitioner, fellow, social worker) and keywords for bias (implicit bias, explicit bias, de-biasing, cultural competence, cultural competency, discrimination, prejudice, health disparity). To be included in this systematic review, a study had to: 1) assess LGBTQ-related bias; 2) include dental, nursing or medical students or practicing medical professionals; 3) include a training program designed to promote culturally-competent care for LGBTQ individuals; 4) be written in English; and 5) be published prior to February 2017. We did not exclude qualitative studies nor did we exclude studies conducted outside of North America.

LIMITATIONS Findings of the systematic review were limited as none addressed the impact of implicit bias training on changing students’ behavior or on patient outcomes. Hence, we could only draw from the extant literature on implicit racial/ethnic bias reduction to generate recommendations for training to address implicit bias towards LGBTQ persons and other vulnerable populations3, 39, 40.

RESULTS/KEY FINDINGS The systematic literature search yielded nine studies that assessed training programs to reduce LGBTQ-related bias in health care professions students and four studies that focused on health care providers. Studies ranged from small sample size (n = 13) to large (n = 848) and represented a wide range of health professions training programs including medicine (n = 6), nursing (n = 2) and dentistry (n = 1), as well as health care providers (n = 4). The programs varied in their delivery format (e.g., lecture, small group discussion, interactive theater workshop), frequency (range: 1 to 6 sessions) and duration (range: 45-minute lecture to 4-week web-based course). Programs designed to increase student or provider knowledge of the LGBTQ community and LGBTQ-relevant health care issues utilized lectures, readings, videos, interviews or presentations by LGBTQ individuals, and group discussion. Significant knowledge gains in knowledge were observed for students attending single-session41-44 and for students and providers attending more time-intensive program formats45, 46. One found that knowledge gains for medical students were maintained three months after the training program46. Programs designed to promote more positive student attitudes toward LGBTQ patients utilized perspective-taking exercises, videos of LGBTQ patients describing discrimination in health care settings, individual presentations, lectures, and LGBTQ patient panels. Strategies that reduce biases in students and providers are likely to increase access to care and reduce health disparities among vulnerable populations.

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DISCUSSION The present review provides direction for researchers and educators seeking to reduce implicit bias among medical students toward LGBTQ patients and other vulnerable populations and provides a blueprint that can be used to train students how to become aware of and address personal biases. While research on programs to reduce bias among medical students is limited, research with health professionals may shed light on the key ingredients of effective programs. This review found that comfort level regarding LGBTQ health care was increased through experiential learning, which is consistent with prior results found in health professions samples47. Once implicit biases have been identified, medical students can be taught strategies to reduce their potential impact on patient care39. Some of these strategies, such as perspective-taking and intergroup contact, were identified in the present review as effective components of programs seeking to promote more positive explicit attitudes and greater comfort working with LGBTQ patients. Strategies that have received support for reducing implicit bias in other populations include: 1) the use of mindfulness meditation to promote nonjudgmental awareness48,49 2) individuation training to encourage providers to focus on individual attributes rather than group membership50; and 3) training in emotion regulation skills to reduce stress levels and negative emotions1,51. Although changes in implicit bias were not assessed using quantitative measures, anecdotal evidence from two studies found that an increase in awareness of implicit bias can be achieved among students41, 52. Future studies and medical school training programs should examine the influence of training on implicit LGBTQ-related bias.

RECOMMENDATIONS/NEXT STEPS A curricular framework for reducing implicit biases among medical students towards LGBTQ persons and other vulnerable populations is needed and offers the potential for transforming medical school education in addressing the needs of vulnerable populations. Training activities and modalities that reduce bias towards LGBTQ persons and other vulnerable populations through increases in knowledge, explicit attitudes, and comfort level are supported by the present review. Results suggest that bias awareness strategies should be practiced in a supportive and individualized learning environment such as patient simulation that provides students with opportunities to receive direct feedback about perceived implicit biases while minimizing student defensiveness39. Towards this end, curricula should emphasize that implicit biases – whether negative or positive – are universal psychological phenomena51. While the Association of American Medical Colleges Advisory Committee on Sexual Orientation, Gender Identity, and Sex Development has generated professional competency objectives, they currently are only advisory. Further review of incorporating professional competency objectives of the needs of LGBTQ and other vulnerable populations into accreditation standards of the Liaison Committee on Medical Education (LCME) should be considered.

ACKNOWLEDGMENTS This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number UH1HP30348, entitled “Academic Units for Primary Care Training and Enhancement.” This information or content and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.

REFERENCES 1. Burgess D, van Ryn M, Dovidio J, Saha S. Reducing Racial Bias Among Health Care Providers: Lessons from SocialCognitive Psychology. Journal of General Internal Medicine. 2007;22(6):882-887. 2. Shavers VL. The state of research on racial/ethnic discrimination in the receipt of health care. Am J Public Health. 2012;102. 3. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol. 2009;62(10):10061012. 4. Carabez R, Pellegrini M, Mankovitz A, Eliason MJ, Dariotis WM. Nursing students’ perceptions of their knowledge of lesbian, gay, bisexual, and transgender issues: effectiveness of a multi-purpose assignment in a public health nursing class. J Nurs Educ. 2015;54(1):50-53. 5. Strong KL, Folse VN. Assessing undergraduate nursing students’ knowledge, attitudes, and cultural competence in caring for lesbian, gay, bisexual, and transgender patients. J Nurs Educ. 2015;54(1):45-49.

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6. Thomas DD, Safer JD. A Simple Intervention Raised ResidentPhysician Willingness to Assist Transgender Patients Seeking Hormone Therapy. Endocr Pract. 2015;21(10):1134-1142. 7. Hardacker CT, Rubinstein B, Hotton A, Houlberg M. Adding silver to the rainbow: the development of the nurses’ health education about LGBT elders (HEALE) cultural competency curriculum. J Nurs Manag. 2014;22(2):257-266. 8. Johnson K, Rullo J, Faubion S. Student-Initiated Sexual Health Selective as a Curricular Tool. Sex Med. 2015;3(2):118127. 9. Johnson TJ, Ellison AM, Dalembert G, et al. Implicit Bias in Pediatric Academic Medicine. Journal of the National Medical Association. 10. Bartos SE, Berger I, Hegarty P. Interventions to reduce sexual prejudice: a study-space analysis and meta-analytic review. J Sex Res. 2014;51(4):363-382. 11. Zestcott, C. A., Blair, I. V. & Stone, J. Examining the presence, consequences, and reduction of implicit bias in health care: A narrative review. Group Process Intergroup Relat. 2016. doi:10.1177/1368430216642029.

12. Williams EC, Bradley KA, Balderson BH, et al. Alcohol and associated characteristics among older persons living with human immunodeficiency virus on antiretroviral therapy. Subst Abus. 2014;35(3):245-253. 13. Remafedi G, French S, Story M, Resnick MD, Blum R. The relationship between suicide risk and sexual orientation: results of a population-based study. Am J Public Health. 1998;88(1):57-60. 14. Quinn GP, Sanchez JA, Sutton SK, et al. Cancer and lesbian, gay, bisexual, transgender/transsexual, and queer/ questioning (LGBTQ) populations. CA Cancer J Clin. 2015;65(5):384-400. 15. Conron KJ, Mimiaga MJ, Landers SJ. A Population-Based Study of Sexual Orientation Identity and Gender Differences in Adult Health. American Journal of Public Health. 2010;100(10):1953-1960. 16. Dilley JA, Simmons KW, Boysun MJ, Pizacani BA, Stark MJ. Demonstrating the Importance and Feasibility of Including Sexual Orientation in Public Health Surveys: Health Disparities in the Pacific Northwest. American Journal of Public Health. 2010;100(3):460-467. 17. Fredriksen-Goldsen KI, Kim H-J, Barkan SE, Muraco A, HoyEllis CP. Health Disparities Among Lesbian, Gay, and Bisexual Older Adults: Results From a Population-Based Study. American Journal of Public Health. 2013;103(10):1802-1809. 18. Bauermeister J, Eaton L, Stephenson R. A Multilevel Analysis of Neighborhood Socioeconomic Disadvantage and Transactional Sex with Casual Partners Among Young Men Who Have Sex with Men Living in Metro Detroit. Behav Med. 2016;42(3):197-204. 19. Smalley KB, Warren JC, Barefoot KN. Differences in Health Risk Behaviors Across Understudied LGBT Subgroups. Health Psychology. 2016;35(2):103-114. 20. Cochran SD, Bandiera FC, Mays VM. Sexual orientationrelated differences in tobacco use and secondhand smoke exposure among US adults aged 20 to 59 years: 2003-2010 National Health and Nutrition Examination Surveys. Am J Public Health. 2013;103(10):1837-1844. 21. Charlton BM, Corliss HL, Missmer SA, et al. Reproductive health screening disparities and sexual orientation in a cohort study of U.S. adolescent and young adult females. J Adolesc Health. 2011;49(5):505-510. 22. Haas AP, Eliason M, Mays VM, et al. Suicide and suicide risk in lesbian, gay, bisexual, and transgender populations: review and recommendations. J Homosex. 2011;58(1):10-51. 23. Buchmueller T, Carpenter CS. Disparities in health insurance coverage, access, and outcomes for individuals in same-sex versus different-sex relationships, 2000-2007. Am J Public Health. 2010;100(3):489-495. 24. Heck JE, Sell RL, Gorin SS. Health care access among individuals involved in same-sex relationships. Am J Public Health. 2006;96(6):1111-1118. 25. Maina IW, Belton TD, Ginzberg S, Singh A, Johnson TJ. A decade of studying implicit racial/ethnic bias in healthcare providers using the implicit association test. Social Science & Medicine. 26. Grant JM, Mottet LA, Tanis J. National Transgender Discrimination Survey Report on Health and Health Care. Washington DC: National Center for Transgender Equality and National Gay and Lesbian Task Force; 2010.

27. Burke SE, Dovidio JF, Przedworski JM, et al. Do Contact and Empathy Mitigate Bias Against Gay and Lesbian People Among Heterosexual Medical Students? A Report from Medical Student CHANGES. Academic medicine : journal of the Association of American Medical Colleges. 2015;90(5):645-651. 28. Sabin JA, Riskind RG, Nosek BA. Health Care Providers’ Implicit and Explicit Attitudes Toward Lesbian Women and Gay Men. Am J Public Health. 2015;105(9):1831-1841. 29. FitzGerald C, Hurst S. Implicit bias in healthcare professionals: a systematic review. BMC Medical Ethics. 2017;18:19. 30. Rowniak SR. Factors Related to Homophobia Among Nursing Students. J Homosex. 2015;62(9):1228-1240. 31. Blair IV, Havranek EP, Price DW, et al. Assessment of Biases Against Latinos and African Americans Among Primary Care Providers and Community Members. American Journal of Public Health. 2012;103(1):92-98. 32. Sullivan PS, Rosenberg ES, Sanchez TH, et al. Explaining racial disparities in HIV incidence in black and white men who have sex with men in Atlanta, GA: a prospective observational cohort study. Annals of epidemiology. 2015;25(6):445-454. 33. Millett GA, Peterson JL, Flores SA, et al. Comparisons of disparities and risks of HIV infection in black and other men who have sex with men in Canada, UK, and USA: a metaanalysis. Lancet. 2012;380(9839):341-348. 34. Mereish EH, Bradford JB. Intersecting Identities and Substance Use Problems: Sexual Orientation, Gender, Race, and Lifetime Substance Use Problems. Journal of Studies on Alcohol and Drugs. 2014;75(1):179-188. 35. Torres CG, Renfrew M, Kenst K, Tan-McGrory A, Betancourt JR, Lopez L. Improving transgender health by building safe clinical environments that promote existing resilience: Results from a qualitative analysis of providers. Bmc Pediatrics. 2015;15. 36. Kamen C, Palesh O, Gerry AA, et al. Disparities in Health Risk Behavior and Psychological Distress Among Gay Versus Heterosexual Male Cancer Survivors. Lgbt Health. 2014;1(2):86-U103. 37. Khan A, Plummer D, Hussain R, Minichiello V. Does physician bias affect the quality of care they deliver? Evidence in the care of sexually transmitted infections. Sexually Transmitted Infections. 2008;84(2):150-151. 38. AAMC Advisory Committee on Sexual Orientation GI, and Sex Development,. Implementing Curricular and Institutional Climate Changes to Improve Health Care for Individuals Who Are LGBT, Gender Nonconforming, or Born with DSD: A Resource for Medical Educators. 2014. 39. Zestcott CA, Blair IV, Stone J. Examining the Presence, Consequences, and Reduction of Implicit Bias in Health Care: A Narrative Review. Group processes & intergroup relations : GPIR. 2016;19(4):528-42. doi:10.1177/1368430216642029 40. Valverde EE, DiNenno EA, Schulden JD, Oster A, Painter T. Sexually transmitted infection diagnoses among Hispanic immigrant and migrant men who have sex with men in the United States. International Journal of Std & Aids. 2016;27(13):1162-9. doi:10.1177/0956462415610679

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41. Carabez R, Pellegrini M, Mankovitz A, Eliason MJ, Dariotis WM. Nursing students’ perceptions of their knowledge of lesbian, gay, bisexual, and transgender issues: effectiveness of a multi-purpose assignment in a public health nursing class. The Journal of nursing education. 2015;54(1):50-3. doi:10.3928/01484834-20141228-03 42. Eriksson SE, Safer JD. Evidence-Based Curricular Content Improves Student Knowledge and Changes Attitudes Towards Transgender Medicine. Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists. 2016;22(7):837-41. doi:10.4158/EP151141.OR 43. Strong KL, Folse VN. Assessing undergraduate nursing students’ knowledge, attitudes, and cultural competence in caring for lesbian, gay, bisexual, and transgender patients. The Journal of nursing education. 2015;54(1):45-9. doi:10.3928/01484834-20141224-07 44. Thomas D.D., Safer J.D. A Simple Intervention Raised Resident-Physician Willingness to Assist Transgender Patients Seeking Hormone Therapy. Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists. 2015;21(10):1134-42. doi:10.4158/EP15777.OR 45. Hardacker CT, Rubinstein B, Hotton A, Houlberg M. Adding silver to the rainbow: the development of the nurses’ health education about LGBT elders (HEALE) cultural competency curriculum. Journal of nursing management. 2014;22(2):25766. doi:10.1111/jonm.12125

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46. Johnson K, Rullo J, Faubion S. Student-Initiated Sexual Health Selective as a Curricular Tool. Sexual medicine. 2015;3(2):118-27. doi:10.1002/sm2.57 47. Turner RN, Crisp RJ, Lambert E. Imagining intergroup contact can improve intergroup attitudes. Group Process Intergroup Relat. 2007;10(4):427-41. doi:10.1177/1368430207081533 48. Lueke A, Gibson B. Mindfulness Meditation Reduces Implicit Age and Race Bias: The Role of Reduced Automaticity of Responding. Soc. Psychol. Personal Sci. 2015;6(3):284-91. doi:10.1177/1948550614559651 49. Stell AJ, Farsides T. Brief loving-kindness meditation reduces racial bias, mediated by positive other-regarding emotions. Motiv. Emot. 2016;40(1):140-7. doi:10.1007/s11031-015-9514-x 50. Stone J, Moskowitz GB. Non-conscious bias in medical decision making: what can be done to reduce it? Medical education. 2011;45(8):768-76. doi:10.1111/j.13652923.2011.04026.x 51. Kirwan Institute. State of the Science: Implicit Bias Review 2016. 2016. 52. Kelley L, Chou CL, Dibble SL, Robertson PA. A critical intervention in lesbian, gay, bisexual, and transgender health: knowledge and attitude outcomes among secondyear medical students. Teaching and learning in medicine. 2008;20(3):248-53. doi:10.1080/10401330802199567

AU-PCTE RESEARCH POLICY BRIEF

Training of Medical Students and Residents in the Administration of Pre-Exposure Prophylaxis: A Systematic Review

EXECUTIVE SUMMARY BACKGROUND Although the incidence of Human Immunodeficiency Virus (HIV) has been declining over the past decade, approximately 50,000 new infections are diagnosed annually in the United States. Men who have sex with men (MSM) and transgender women continue to have higher rates of infection in the US. MSM make up 58% of people living with HIV, although they only account for 2% of the population. People who inject drugs (PWID) account for an additional 8% of newly diagnosed HIV infections while African American women account for 19%. A growing body of research has shown high levels of Pre-exposure prophylaxis (PrEP) efficacy in reducing the risk of contracting HIV. PrEP has been found to reduce the risk of infection between 44% and 86%, and with greater adherence, reductions are even higher. Despite the high efficacy of PrEP, prescription rates remain low. The study was guided by two questions: 1) Are medical students currently being taught how to prescribe PrEP for patients who are at risk for HIV? 2) What are the barriers to prescribing PrEP?

METHODS A systematic review of the literature was conducted using three databases (PubMed, CINAHL, & Web of Science) to address the research questions. Search terms included: HIV prevention, pre-exposure prophylaxis, primary care, medical education and training. A total of 560 articles were found. Titles and abstracts were reviewed to determine relevance to the research questions and eliminate duplicate articles reducing this number to 26. The full text of the 26 articles were then reviewed for relevance to the research questions. Twenty-one (21) articles remained for inclusion in this review.

RESULTS No articles or studies were found that focused on how prescribing PrEP is being taught to medical students. Barriers to prescribing PrEP by practicing primary care providers were identified, however, and a PrEP cascade for prescribing PrEP was identified.

RECOMMENDATIONS This review included four recommendations: 1) Medical schools should adapt a universal PrEP curriculum for its patient population using the PrEP cascade model; 2) medical students should be taught how to universally screen candidates for PrEP appropriateness (MSM, transgender women, discordant couples, African American women, young persons who have multiple partners, and PWID); 3) Medical students need to be familiar with patient medication assistance programs; and 4) medical students need to be taught how to monitor PrEP adherence.

KEY STAKEHOLDERS Key stakeholders include but are not limited to academic medical institutions, medical education accreditation bodies, health care providers, advocacy groups, health insurance providers, pharmaceutical companies, public health officials, policymakers, health professions associations, and populations at risk.

ISSUE While new diagnoses of HIV have been declining over the past decade, approximately 50,000 new infections are diagnosed annually in the United States.1 Pre-Exposure Prophylaxis (PrEP), a once daily combination antiretroviral medication (tenofivir and emtricitabine) has been shown in multiple studies to reduce the risk of infection by between 44% and 86%,2 and with greater adherence, reductions are even higher.3,4 While it is estimated that 1.2 million people could benefit from taking PrEP, currently only 49,000 are taking this medication.5 Persons at highest risk for HIV transmission, include men who have sex with men (MSM), transgender females, injection drug users, discordant couples, and women with multiple sex partners, particularly African American women. These sub-populations have been identified as appropriate candidates for pre-exposure prophylaxis (PrEP). This study was guided by two research questions: 1) Are medical students currently being taught how to prescribe PrEP for patients who are at risk for HIV?; and 2) What are the barriers to prescribing PrEP?

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BACKGROUND The efficacy of PrEP as a preventative measure, has been tested in multiple studies,14-20 and meta-analyses21,22 and findings suggest that, when used consistently, PrEP results in significantly decreased rates of HIV infection. A recent meta-analysis of PrEP efficacy confirmed that PrEP was equally effective for men and women.23 Despite the high level of efficacy of PrEP, less than 4.2% of persons in the US who would benefit from it, currently have a PrEP prescription. In order for PrEP to reach its full potential in reducing HIV, those individuals at highest risk must gain widespread access. This access will only be achieved by increasing the pool of willing and able prescribing physicians and consumers. While barriers to PrEP prescribing to at-risk populations have been noted in the literature,33-53 training medical students to prescribe will be critical to the full realization of PrEP’s preventive possibilities. While PrEP is an important tool for ending the HIV epidemic. Yet, there is no evidence that US medical schools currently are training students how to administer PrEP. Knowledge among primary care providers about PrEP is low and medical students are not being taught to prescribe it. To reduce the incidence of HIV infection, accrediting bodies should take a position on making the integration of PrEP prescription training mandatory in all all US medical schools. The goals of this review were to determine prescribing practices of primary care physicians, how prescribing was taught in medical schools and to make recommendations for enhancements in medical education to ensure that physicians entering practice will have the knowledge, skills, and intent to deliver PrEP to at-risk populations with the long term aim of ending the HIV epidemic. The need to develop curricula that include PrEP training is directly in line with the National HIV/AIDS prevention strategy to better equip doctors with the skills needed to reduce the incidence of HIV. We organized our findings utilizing the PrEP cascade,34 (see Table 1.) and provide both content and educational delivery method recommendations.

METHODS To address the research questions, a systematic review of articles was conducted from four databases (PubMed, CINAHL, Web of Science and PsycInfo). Search terms, inclusion and exclusion criteria were developed to conduct the systematic review. Initially, a total of 560 articles were found that met the search criteria. Next, titles and abstracts were reviewed to determine relevance to the research questions and to eliminate duplicate articles which reduced this number to 26. The full text of the 26 articles were then reviewed for relevance to the research questions. The CORE-Q checklist 54 was used to review qualitative studies and the STROBE checklist 55 for cross sectional surveys. After the full text review, 21 articles remained for inclusion in the review.

LIMITATIONS The limitations of our study included the small sample size of articles that fit the search criteria, and the gaps in current literature regarding physicians’ knowledge, skills, and prescription behavior regarding PrEP. The most evident gap is the lack of studies that have examined the effectiveness of PrEP prescription training to medical students on increasing PrEP prescription behavior. In addition, few studies have examined the rate of at-risk patients who may benefit from PrEP prescription in primary care.

RESULTS The systematic review found no articles or studies that focused on how PrEP prescription is being taught to medical students. Results found, however, that among health care providers, there has been much confusion about whether PrEP should be delivered by HIV specialists or by primary care providers.34 The purview barrier refers to HIV specialists being the most informed and skilled in the delivery of antiretrovirals, contrasted with the need for primary care physicians to deliver PrEP as they are more likely to encounter high risk, HIV negative persons. Generalists often cited the lack of knowledge about antiretroviral medications as a barrier to implementing PrEP in general practice settings.40,43,50 A national study of PrEP providers conducted annually from 2009-201544 found that HIV specialists were most likely to prescribe PrEP, but over time, the number of primary care physicians prescribing PrEP has steadily risen.42,43 Other systemic provider concerns identified, included a lack of resources to support prescriptions for PrEP patients,34,45,52 and the need for adherence monitoring.33,37,40,47-52 PrEP prescription without financial assistance is expensive, and many patients that may benefit most from PrEP may not have insurance or a means to pay for the prescription. Physicians in several of the studies noted this concern.34,45,52 However, a wealth of resources were identified to support patients that are appropriate candidates for the medication, including the Patient Advocacy Foundation, Gillead Sciences, and many state based programs.33 Additionally, for PrEP to be successful, adherence must be monitored and encouraged and regular check-ups are included in the PrEP protocol to identify any adverse consequences from the medication. 33,37,40,47-52 To achieve this, providers will need to increase patient communication regarding sexual risk, increase knowledge and willingness to prescribe PrEP, identify patient sexual risk behavior, and discuss these risks non-judgmentally. Each of these factors can decrease the likelihood of providers prescribing PrEP.

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DISCUSSION For PrEP to be delivered on a scale that can reduce HIV transmission among at-risk populations and fulfill its potential role for ending the epidemic, consensus among medical educators on the venue for PrEP must be agreed upon and communicated. Delivering PrEP in primary care settings will require sexual histories to be taken regularly, HIV testing to be performed more frequently, and HIV prevention messages to be delivered in culturally appropriate ways and made universally to a wide range of patients. Medical students must be exposed to training in LGBTQ and PWID affirming practices. In order for PrEP to be delivered in real world settings, primary care physicians will need training to identify appropriate candidates for PrEP based on risk assessment, patient data from electronic medical records, patient preferences for use of chemoprophylaxis, and to become comfortable in prescribing and monitoring patient adherence and knowledge about patient assistance programs. Primary care residency training programs might focus on low cost methods (i.e., self-report for monitoring adherence in the patient-centered medical home clinical setting to ensure cost of PrEP remains low and available to promote patient adherence. Because mental health and substance abuse are factors that impact adherence and retention, medical students should receive training in screening and intervention approaches to ensure these barriers do not affect medication adherence. These skills have broad applicability and can easily be integrated into the medical school education curriculum. If PrEP is to be a viable preventive measure and to realize its potential in ending the HIV epidemic, physicians must be trained to deliver PrEP and barriers to prescribing it must be addressed in training. Integrating PrEP prescription training into the curriculum will aid in the fight to end the HIV epidemic. The PrEP cascade was identified as a framework for teaching medical students and residents the requisite knowledge and skills to deliver PrEP in their future practice and for assessing PrEP delivery and adherence. The PrEP Cascade, adapted from Liu, Colfax, Bacon, Kolber, et al. (2015) is presented in Table 1.

TABLE 1: ELEMENTS OF THE PREP CASCADE AND EDUCATIONAL RECOMMENDATIONS PrEP Cascade

Educational Recommendations

Identify populations at risk for HIV

»» Utilize health services research projects to familiarize students and residents with population and individual risk.

Identify PrEP candidate

»» Create algorithms in Electronic Health Record (EHR) systems to identify those at high risk for HIV. »» Increase community knowledge of PrEP through educational materials, and PrEP testimonials from PrEP users.

Train medical students about PrEP prescription

»» Address student bias/cultural competence regarding risk populations. Increase student/resident knowledge of PrEP. »» Utilize HIV specialist knowledge to train medical students about pharmacology, anti-retro viral therapy, and side effects. »» Teach students to conduct culturally appropriate sexual risk history. »» Increase sexual risk assessment training, make standard of care in teaching hospitals. »» Develop behavioral intervention to increase PrEP interest.

Link to PrEP

»» Teach students how to prescribe PrEP. »» Allow students to shadow PrEP delivery sessions. »» Develop simulated patient encounters to develop student skills in PrEP prescription and adherence.

Initiate PrEP prescription

»» Teach students to assess patients for medical assistance program eligibility.

Track PrEP adherence

»» Utilize PrEP navigators and other support staff to track retention. »» Introduce patient interactive messaging to residents and students as a means to improve adherence.

Achieve adherence and persistence

»» Train students to monitor adherence via self-reported adherence measures as standard care. »» Increase substance abuse and mental health screening, and referral, perhaps using Screening, Brief Intervention and Referral to Treatment (SBIRT) type models.

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RECOMMENDATIONS This review included four recommendations: 1) Medical schools should adapt a universal PrEP curriculum for its patient population using the PrEP cascade model; 2) medical students should be taught how to universally screen candidates for PrEP appropriateness (MSM, transgender women, discordant couples, African American women, young persons who have multiple partners, and PWID); 3) Medical students need to be familiar with patient medication assistance programs; and 4) medical students need to be taught how to monitor PrEP adherence.

ACKNOWLEDGMENTS This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number UH1HP30348, entitled “Academic Units for Primary Care Training and Enhancement.” This information or content and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.

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36. Mimiaga M.J., White J.M, Krakower D.S, Biello K.B, Mayer K.H. Suboptimal awareness and comprehension of published pre-exposure prophylaxis efficacy results among physicians in Massachusetts. AIDS Care 2014; 26(6)684-693. Doi:10.1080/ 09540121.2013.845289 37. Karakower D.S, Oldenburg C.E, Mitty J.A, Wilson I.B, Kirth A.E, Maloney K.M…Mayer K.H. Knowledge, Beliefs and Practices Regarding Antiretroviral Medications for HIV Prevention: Results from a Survey of Healthcare Providers in New England. PLoSONE. 2015 10(7) doi: 10.1371/journal. pone.0132398 38. Castel A.D, Feaster D.J, Tang W, Willis S, Jordan H, Villamizar K… Metsch L. Understanding HIV Care Provider Attitudes Regarding Intentions to Prescribe PrEP. Journal of Acquired Immune Deficiency Syndrome. 2015 70(5) 520-528. Doi: 10.1097/QAI.0000000000000780 39. Adams L.M, Balderson B.H. HIV Providers’ Likelihood to Prescribe Pre-exposure Prophylaxis (PrEP) for HIV Prevention Differs By Patient Type: A Short Report. AIDS Care. 2016 28(9) 1154-1158. Doi: 10.1080/09540121.2016.1153595 40. Bacon O, Gonzalez R, Andrew E, Potter M.B, Iniguez J R, Cohen S.E…Fuchs J.D. Informing Strategies to Build PrEP Capacity Among San Francisco Bay Area Clinicians. J Acquir Immune Defic Syndr. 2017;7;74:175—179 41. Walsh J.L, Petrol A.E. Factors Related to Pre-exposure Prophylaxis Prescription by U.S. Primary Care Physicians. American Journal of Preventive Medicine. 2017;52(6):e165-e072 42. Hakre S, Blaylock J.M, Dawson P, Beckett C, Garges E.C, Michael N.L… Olulicz J.F. Knowledge, attitudes, and beliefs about HIV pre-exposure prophylaxis among US Air Force Health Care Providers. Medicine. 2016 95:32(e4511) 43. Blackstock O.J, Moore B.A, Berkenblit G.V, Calabrese S.K, Cunningham C.O, Fiellin D.A… Edelman E.J. A CrossSectional Online Survey of HIV Pre-Exposure Prophylaxis Adoption Among Primary Care Physicians. J Gent Intern Med. 2016 32(1):62-70. Doi: 10.1007/s11606-016-3903-z 44. Smith D.K, Mendoza M.C.B, Stryker J.E, Rose C.E. PrEP Awareness and Attitudes in a National Survey of Primary Care Clinicians in the United States 2009-2015. PLoSONE. 11(6):e0156592. Doi: 10.1371/journal.pone.0156592 45. Petroll A.E, Walsh J.L, Owczarzak J.L, McAuliffe T.L, Bogart L.M, Kelly J.A. PrEP Awareness, Familiarity, Comfort, and Prescribing Experiences among US Primary Care Providers and HIV Specialists. AIDS Behav. 2017. 21:1256-1267. DOI 10.1007/s10461-016-1625-1 46. Edelman E.J, Moore B.A, Calabrese S.K, Berkenblit G, Cunningham C, Patel V, Phillips K… Blackstock O. Primary Care Physicians’ Willingness to Prescribe HIV Pre-exposure Prophylaxis for People who Inject Drugs. 47. Karris M.Y, Beekmann S.E, Mehta S.R, Anderson C.M, Polgreen P.M. 48. Hoffman S, Guidry J.A, Collier K.L, Mantell J.E, BroccherLattimore D, Kaighobadi F, Sandfot T.G.M. A Clinical Home for Pre Exposure Prophylaxis (PrEP): Diverse Health Care Providers’ Perspectives on the “Purview Paradox”. J Int Assoc Provid AIDS Care. 2016. 15(1):59-65. Doi: 10.1177/2325957415600798.

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49. Arnold E.A, Hazelton P, Lane T, Christopoulos K.A, Galindo G.R, Steward W.T, Moring S.F. A Qualitative Study of Provider Thoughts on Implementing Pre-Exposure Prophylaxis (PrEP) in Clinical Settings to Prevent HIV Infection. PLos ONE. 2012. 7(7):e40603. Doi: 10.1371/journal.pone.0040603. 50. Krakower D.S, Ware N.C, Maloney K.M, Wilson I.B, Wong J.B, Mayer K.H. Differing Experiences with Pre-Exposure Prophylaxis in Boston Among Lesbian, Gay, Bisexual, and Transgender Specialists and Generalists in Primary Care: Implications for Scale-Up. AIDS Patient Care and STDS. 2017. 31(7). Doi: 10.1089/apc.2017.0031. 51. Blumenthal J, Jain S, Krakower D, Sun X, Young J, Mayer K, Haubrich R. Kowledge is Power! Increase Provider Knowledge Scores regarding Pre-exposure Prophylaxis (PrEP) are Associated with Higher Rates of PrEP Prescription and Future Intent to Prescribe PrEP. AIDS Behav. 2015 May; 19(5): 802-810. doi: 10.1007/s10461-015-0996-z. 52. Finocchario-Kessler S, Champassak S, Hoyt M.J, Short W, Chakraborty R, Weber S… Anderson J. Pre-Exposure Prophylaxis (PrEP) for Safer Conception Among Serodifferent Couples: Findings from Healthcare Providers Serving Patients with HIV in Seven US Cities. AIDS Patients Care and STDs. (2016). 30(3). Doi:10.1089.apc.20150268. 53. Calabrese S.K, Magnus M, Mayer K.H, Krakower D.S, Eldahan A.I, Gaston L.A…Dovidio J.F. “Support Your Client at the Space That They’re in”: HIV Pre-Exposure Prophylaxis (PrEP) Prescribers’ Perspectives on PrEP- Related Risk Compensation. AIDS Patient Care and STDs. (2017). 31(4). Doi: 10.1089.apc.2017.0002. 54. Fortin, M., Stewart, M., Poitras, Marie-Eve, Almirall, J., & Maddocks, H. (2012). A systematic review of prevalence studies on multimorbidity: Toward a more uniform methodology. Annals of Family Medicine, 10(2). 55. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): A 32 item checklist for interviews and focus groups. Int J Qual Health Care. 2007; 19(6): 349-357. 56. Liu, A.; Colfax, G.; Cohen, S.; Bacon, O.; Kolber, M.; Amico, KR., et al., editors. 7th International conference on HIV treatment and prevention adherence. Florida: Miami Beach; 2012. The spectrum of engagement in HIV prevention: proposal for a PrEP cascade. 57. von Elm, E., Altman,D.G., Egger, M., Pocock, S.J., Gotzsche, P.C., & Vandenbroucke, J.P. (2007). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Annals of Internal Medicine, 147(8), 573-577. 58. CDC. HIV and Injection Drug Use: Syringe Services Programs for HIV Prevention. Vital Signs. December 2016. 59. Reif S, Safley D, Wilson E, Whetten K. HIV/AIDS in the Southern US: Trends from 2008-2011 show a consistent disproportionate epidemic. http://southernaidsstrategy.org/ research/. Accessed July 25, 2014.

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60. Reif S, Pence BW, Hall I, Hu X, Whetten K, Wilson E. HIV Diagnoses, prevalence and outcomes in nine Southern States J Community Health 2014 Dec 19. [Epub ahead of print]. 61. Quinn, G. P., Sanchez, J. A., Sutton, S. K., Vadaparampil, S. T., Nguyen, G. T., Green, B. L., … Schabath, M. B. (2015). Cancer and lesbian, gay, bisexual, transgender/transsexual, and queer/questioning (LGBTQ) populations. CA: A Cancer Journal for Clinicians, 65(5), 384-400. doi:10.3322/caac.21288 [doi] 62. Conron KJ, Mimiaga MJ, Landers SJ. A population-based study of sexual orientation identity and gender differences in adult health. American Journal of Public Health. 2010;100(10):1953–1960. doi: 10.2105/AJPH.2009.174169. 63. Dilley JA, Simmons KW, Boysun MJ, Pizacani BA, Stark MJ. Demonstrating the importance and feasibility of including sexual orientation in public health surveys: Health disparities in the Pacific Northwest. American Journal of Public Health. 2010;100(3):460–467. doi: 10.2105/AJPH.2007.130336. 64. Fredriksen-Goldsen KI, Kim HJ, Barkan SE, Muraco A, HoyEllis CP (2013). Health disparities among lesbian, gay, and bisexual older adults: results from a population-based study. Am J Public Health, 103(10):1802-9. 65. Calabrese S.K, Earnshaw V.A, Underhill K, Hansen N.B, Dovidio J.F. The Impact of Patient Race on Clinical Decisions Related to Prescribing HIV Pre-Exposure Prophylaxis (PrEP): Assumptions About Sexual Risk Compensation and Implications for Access. AIDS Behav. 2014 February; 18(2): 226-240. doi: 10.1007/s10461-013-0675-x. 66. Lehman, D. A. and others. Risk of drug resistance among persons acquiring HIV within a randomized clinical trial of single- or dual-agent preexposure prophylaxis.Journal of Infectious Diseases. 2015. 67. Grant, R. M. & Liegler, T. Weighing the risk of drug resistance with the benefits of HIV preexposure prophylaxis. Journal of Infectious Diseases. Journal of Infectious Diseases. 2015. 68. Kalichman, S.C., Amaral, C.M., Swetzes, C., Jones, M., Macy, R., Kalichman, M.O., & Cherry, C. (2009). A simple single item rating scale to measure medication adherence: Further evidence for convergent validity. Journal of the International Physicians AIDS Care, 8(6), 367-374. doi:10.1177/1545109709352884[doi] 69. Cooper, R.L., Juarez P., Morris M., Edgerton R., Brown L.S., Ramesh A., Tabatabai M., Im, W., Arcury T.A., Mena L.,Collins, S., Juarez P.M. (2017). Training for Medical Students and Residents in the Administration of Pre-Exposure Prophylaxis: A Systematic Review (In preparation, 2018).

2017 CONFERENCE

Selected Readings on Vulnerable Populations by Topics for Communities of Practice

MEDICAL EDUCATION Ahrweiler, F., et al. (2014). “Clinical practice and self-awareness as determinants of empathy in undergraduate education: A qualitative short survey at three medical schools in Germany.” GMS Zeitschrift für Medizinische Ausbildung 31(4): Doc46. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4259065/

Akaike, M., et al. (2012). “Simulation-based medical education in clinical skills laboratory.” The Journal of Medical Investigation 59(1,2): 28-35.

El Rayess, F., et al. (2015). “Patient-Centered Medical Home Knowledge and Attitudes of Residents and Faculty: Certification Is Just the First Step.” Journal of Graduate Medical Education 7(4): 580-588. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4675415/

Hardeman, R. R., et al. (2015). “Medical student socio-demographic characteristics and attitudes toward patient centered care: Do race, socioeconomic status and gender matter? A report from the Medical Student CHANGES study.” Patient education and counseling 98(3): 350-355.

Banwari, G., et al. (2015). “Medical students and interns’ knowledge about and attitude towards homosexuality.” Journal of Postgraduate Medicine 61(2): 95-100.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4433154/

Brauer, D. G. and K. J. Ferguson (2015). “The integrated curriculum in medical education: AMEE Guide No. 96.” Medical teacher 37(4): 312-322.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4617779/

Burgess, D. J., et al. (2016). “Medical students’ learning orientation regarding interracial interactions affects preparedness to care for minority patients: a report from Medical Student CHANGES.” BMC Medical Education 16: 254.

http://www.tandfonline.com/doi/full/10.1080/10401334.2015.1108198

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4943442/

http://www.tandfonline.com/doi/full/10.3109/0142159X.2014.970998

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5041316/

Davis, M. H. and R. M. Harden (2003). “Planning and implementing an undergraduate medical curriculum: the lessons learned.” Medical teacher 25(6): 596-608. http://www.tandfonline.com/doi/abs/10.1080/0142159032000144383

Rdesinski, R. E., et al. (2015). “Development and use of an instrument adapted to assess the clinical skills learning environment in the preclinical years.” Medical science educator 25(3): 285-291. To, M. J., et al. (2016). “Homelessness in the Medical Curriculum: An Analysis of Case-Based Learning Content From One Canadian Medical School.” Teaching and Learning in Medicine 28(1): 35-40. Wilcox, M. V., et al. (2017). “Medical students’ perceptions of the patient-centredness of the learning environment.” Perspectives on Medical Education 6(1): 44-50. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5285277/

Zick, A., et al. (2007). “First-year medical students’ assessment of their own communication skills: A video-based, open-ended approach.” Patient education and counseling 68(2): 161-166. http://www.sciencedirect.com/science/article/pii/S0738399107002236

Harden, R. M. (2001). “AMEE Guide No. 21: Curriculum mapping: a tool for transparent and authentic teaching and learning.” Medical teacher 23(2): 123-137. http://www.tandfonline.com/doi/abs/10.1080/01421590120036547

Frank, E., et al. (2004). “Personal and clinical exercise-related attitudes and behaviors of freshmen U.S. medical students.” Research Quarterly for Exercise & Sport 75. http://www.tandfonline.com/doi/abs/10.1080/02701367.2004.10609142

Kiesewetter, J., et al. (2013). “Training of Leadership Skills in Medical Education.” GMS Zeitschrift für Medizinische Ausbildung 30(4): Doc49. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3839077/

Okuda, Y., et al. (2009). “The Utility of Simulation in Medical Education: What Is the Evidence?” Mount Sinai Journal of Medicine: A Journal of Translational and Personalized Medicine 76(4): 330-343. http://onlinelibrary.wiley.com/doi/10.1002/msj.20127/abstract

Przedworski, J. M., et al. (2015). “A Comparison of the Mental Health and Well-Being of Sexual Minority and Heterosexual First-Year Medical Students: A Report From Medical Student CHANGES.” Academic medicine : journal of the Association of American Medical Colleges 90(5): 652-659. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4414698/

Selected Readings on Vulnerable Populations

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COMMUNITIES OF PRACTICE Barnett, S., et al. (2014). “Implementing a Virtual Community of Practice for Family Physician Training: A Mixed-Methods Case Study.” Journal of Medical Internet Research 16(3): e83. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3967123/

Cambridge D, K., S & Suter, V. (2005) Community of Practice Design GuideStep-by-Step Guide for Designing and Cultivating Communities of Practice https://net.educause.edu/ir/library/pdf/nli0531.pdf

Kimble, C., Hildreth, PM, & Bourdon, I (2008). Communities of practice: Creating learning environments for educators. Charlotte, NC, Omfpr,atopm Age {ib. Krug EG, D., LL, Mercy, JA, Zwi, AB, Lozano, R (2002). World report on violence and health. W. H. Organization. Geneva. Nasca, T. J. and I. Philibert (2009). “Communities of Practice and Learning: Disseminating Their Work.” Journal of Graduate Medical Education 1(1): 164-165. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2931189/

PG, H. C. K. (2005). “Using technology to transform communities of practice into knowledge-building communities.” SIGGROUP Bulletin 25(1): 31-40.

Pérez-Figueroa, R. E., et al. (2015). “ACCEPTABILITY OF PrEP UPTAKE AMONG RACIALLY/ETHNICALLY DIVERSE YOUNG MEN WHO HAVE SEX WITH MEN: THE P18 STUDY.” AIDS education and prevention : official publication of the International Society for AIDS Education 27(2): 112-125. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4550097/

Krakower, D. S. and K. H. Mayer (2015). “Pre-Exposure Prophylaxis to Prevent HIV Infection: Current Status, Future Opportunities and Challenges.” Drugs 75(3): 243-251. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4354703/

Kelley, C. F., et al. (2015). “Applying a PrEP Continuum of Care for Men Who Have Sex With Men in Atlanta, Georgia.” Clinical Infectious Diseases 61(10): 1590-1597. https://academic.oup.com/cid/article/61/10/1590/302887/Applying-a-PrEPContinuum-of-Care-for-Men-Who-Have

Golub, S. A., et al. (2013). “From Efficacy to Effectiveness: Facilitators and Barriers to PrEP Acceptability and Motivations for Adherence Among MSM and Transgender Women in New York City.” AIDS Patient Care and STDs 27(4): 248-254. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3624632/

Richardson, J. E., et al. (2015). “A needs assessment of health information technology for improving care coordination in three leading patient-centered medical homes.” Journal of the American Medical Informatics Association 22(4): 815-820.

Frankis, J., et al. (2016). “Who Will Use Pre-Exposure Prophylaxis (PrEP) and Why?: Understanding PrEP Awareness and Acceptability amongst Men Who Have Sex with Men in the UK – A Mixed Methods Study.” PLoS ONE 11(4): e0151385.

Roland, D., et al. (2017). “Preliminary Evidence for the Emergence of a Health Care Online Community of Practice: Using a Netnographic Framework for Twitter Hashtag Analytics.” J Med Internet Res 19(7): e252.

Deutsch, M. B., et al. (2015). “HIV pre-exposure prophylaxis in transgender women: a subgroup analysis of the iPrEx trial.” The Lancet HIV 2(12): e512-e519.

https://academic.oup.com/jamia/article-lookup/doi/10.1093/jamia/ocu039

http://www.jmir.org/2017/7/e252/

Saint-Onge, H., & Wallace, D (2003). Leveraging communities of practice for strategic advantage. Boston, MA, ButterworthHeinemann. Soubhi, H., et al. (2010). “Learning and Caring in Communities of Practice: Using Relationships and Collective Learning to Improve Primary Care for Patients with Multimorbidity.” Annals of Family Medicine 8(2): 170-177. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2834724/

Walsh, K. and S. Barnett (2014). “Virtual Communities of Practice: Overcoming Barriers of Time and Technology.” J Med Internet Res 16(7): e185. http://www.jmir.org/2014/7/e185/

Welsh, S., Sherriff A, Flodgren G (2015) The champion for improved delivery of care to older people in long-term care settings: effects on professional practice, quality of care and resident outcomes. Cochrane Database of Systematic Reviews 11, http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD011956/epdf

Wenger, E., McDermott, RA, & Snyder, W (2002). Cultivating communities of practice: A guide to managing knowlege. Boston, Harvard Business School Press.

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PRE-EXPOSURE PROPHYLAXIS (PREP) IN VULNERABLE POPULATIONS

Selected Readings on Vulnerable Populations

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4836740/

http://www.sciencedirect.com/science/article/pii/S2352301815002064

Buchbinder, S. P., et al. (2014). “Who should be offered HIV preexposure prophylaxis (PrEP)?: A secondary analysis of a Phase 3 PrEP efficacy trial in men who have sex with men and transgender women.” The Lancet infectious diseases 14(6): 468-475. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4133171/

IMPLICIT BIAS Drewniak, D., et al. (2017). “Do attitudes and behavior of health care professionals exacerbate health care disparities among immigrant and ethnic minority groups? An integrative literature review.” International Journal of Nursing Studies 70: 89-98. http://www.sciencedirect.com/science/article/pii/S0020748917300494

FitzGerald, C. and S. Hurst (2017). “Implicit bias in healthcare professionals: a systematic review.” BMC Medical Ethics 18: 19. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5333436/ Gonzalez, C. M., et al. (2014). “Implicit Bias and Its Relation to Health Disparities: A Teaching Program and Survey of Medical Students.” Teaching and Learning in Medicine 26(1): 64-71. http://www.tandfonline.com/doi/abs/10.1080/10401334.2013.857341

Jensen, N. M. (2014). “Physicians and Implicit Bias.” Journal of General Internal Medicine 29(5): 707-707. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4000338/

Jilani, D., et al. (2015). “Pre-clinical versus clinical medical students’ attitudes towards the poor in the United States.” Journal of Educational Evaluation for Health Professions 12: 52. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4671180/

Maina, I. W., et al. 2017 “A decade of studying implicit racial/ethnic bias in healthcare providers using the implicit association test.” Social Science & Medicine. http://www.sciencedirect.com/science/article/pii/S0277953617303039

Paradies, Y., et al. (2014). “A Systematic Review of the Extent and Measurement of Healthcare Provider Racism.” Journal of General Internal Medicine 29(2): 364-387. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3912280/

Phelan, S. M., et al. (2015). “The mixed impact of medical school on medical students’ implicit and explicit weight bias.” Medical education 49(10): 983-992. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4755318/

Sabin, J. A. and A. G. Greenwald (2012). “The Influence of Implicit Bias on Treatment Recommendations for 4 Common Pediatric Conditions: Pain, Urinary Tract Infection, Attention Deficit Hyperactivity Disorder, and Asthma.” American Journal of Public Health 102(5): 988-995. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3483921/

Saha, S., et al. (2008). “Racial and Ethnic Disparities in the VA Health Care System: A Systematic Review.” Journal of General Internal Medicine 23(5): 654-671. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2324157/

Schiekirka, S., et al. (2014). “Assessment of two different types of bias affecting the results of outcome-based evaluation in undergraduate medical education.” BMC Medical Education 14: 149-149. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4112834/

van Ryn, M., et al. (2015). “Medical School Experiences Associated with Change in Implicit Racial Bias Among 3547 Students: A Medical Student CHANGES Study Report.” Journal of General Internal Medicine 30(12): 1748-1756. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4636581/

Williams, R. L., et al. (2015). “Racial, Gender, and Socioeconomic Status Bias in Senior Medical Student Clinical Decision-Making: A National Survey.” Journal of General Internal Medicine 30(6): 758-767.

TEACHING MEDICAL AND DENTAL STUDENTS ABOUT VULNERABLE POPULATIONS LGBTQ Joan I. Anderson, D. D. S., April N. Patterson, D.D.S., Henry J. Temple, D.D.S. and Marita Rohr Inglehart, Dr. phil. habil. (2009). “Lesbian, Gay, Bisexual, and Transgender (LGBT) Issues in Dental School Environments: Dental Student Leaders’ Perceptions.” Journal of Dental Education 73(1): 105-118. Brondani MA1, P. R. (2011). “Teaching lesbian, gay, bisexual, and transgender issues in dental education: a multipurpose method.” J Dental Educ 75(10): 1354-1361. Corliss, H. L., et al. (2011). “High Burden of Homelessness Among Sexual-Minority Adolescents: Findings From a Representative Massachusetts High School Sample.” American Journal of Public Health 101(9): 1683-1689. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3154237/

Cruz, T. M. (2014). “Assessing access to care for transgender and gender nonconforming people: A consideration of diversity in combating discrimination.” Social Science & Medicine 110: 65-73. http://www.sciencedirect.com/science/article/pii/S0277953614002111

Herman, T. N. T. B. a. J. L. (2015). INTIMATE PARTNER VIOLENCE AND SEXUAL ABUSE AMONG LGBT PEOPLE: A REVIEW OF EXISTING RESEARCH. Los Angeles, CA, The Williams Institute, UCLA School of Law https://williamsinstitute.law.ucla.edu/wp-content/uploads/IntimatePartner-Violence-and-Sexual-Abuse-among-LGBT-People.pdf

Keuroghlian, A. S., et al. (2014). “Out on the Street: A Public Health and Policy Agenda for Lesbian, Gay, Bisexual, and Transgender Youth Who Are Homeless.” The American journal of orthopsychiatry 84(1): 66-72. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4098056/

Poteat, T., et al. (2013). “Managing uncertainty: A grounded theory of stigma in transgender health care encounters.” Social Science & Medicine 84: 22-29. http://www.sciencedirect.com/science/article/pii/S0277953613001019

Roberts, T. K. and C. R. Fantz (2014). “Barriers to quality health care for the transgender population.” Clinical Biochemistry 47(10–11): 983-987. http://www.sciencedirect.com/science/article/pii/S0009912014000708

HOMELESS Edidin, J. P., et al. (2012). “The Mental and Physical Health of Homeless Youth: A Literature Review.” Child Psychiatry & Human Development 43(3): 354-375. https://link.springer.com/article/10.1007%2Fs10578-011-0270-1

Heerde, J. A., et al. (2015). “Associations Between Youth Homelessness, Sexual Offenses, Sexual Victimization, and Sexual Risk Behaviors: A Systematic Literature Review.” Archives of sexual behavior 44(1): 181-212. https://link.springer.com/article/10.1007%2Fs10508-014-0375-2

Keeshin, B. R. and K. Campbell (2011). “Screening homeless youth for histories of abuse: Prevalence, enduring effects, and interest in treatment.” Child Abuse & Neglect 35(6): 401-407. http://www.sciencedirect.com/science/article/pii/S0145213411001128

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4441663/

Selected Readings on Vulnerable Populations

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Homelessness, N. C. o. F. (2013). The characteristics and needs of families experiencing homelessness. http://www.familyhomelessness.org/media/147.pdf

Vijayaraghavan, M., et al. (2012). “Health, Access to Health Care, and Health Care use Among Homeless Women with a History of Intimate Partner Violence.” Journal of community health 37(5): 1032-1039. https://link.springer.com/article/10.1007%2Fs10900-011-9527-7

Tyler, K. A., et al. (2004). “Risk Factors for Sexual Victimization Among Male and Female Homeless and Runaway Youth.” Journal of Interpersonal Violence 19(5): 503-520. http://journals.sagepub.com/doi/abs/10.1177/0886260504262961

To, M. J., et al. (2016). “Homelessness in the Medical Curriculum: An Analysis of Case-Based Learning Content From One Canadian Medical School.” Teaching and Learning in Medicine 28(1): 35-40. http://www.tandfonline.com/doi/full/10.1080/10401334.2015.1108198

Rafferty, Y. S., Marybeth (1991). “The impact of homelessness on children.” American Psychologist 46(11): 1170-1179. Kilmer, R. P. C., James R.; Crusto, Cindy; Strater, Katherine P.; Haber, Mason G. (2012). “Understanding the ecology and development of children and families experiencing homelessness: Implications for practice, supportive services, and policy. .” American Journal of Orthopsychiatry 82(3): 389-401. Vijayaraghavan, M., et al. (2012). “Health, Access to Health Care, and Health Care use Among Homeless Women with a History of Intimate Partner Violence.” Journal of community health 37(5): 1032-1039.

ADVERSE CHILDHOOD EXPERIENCES Anda, R., Felitti, VJ, Walker, J, Whit, CL (2006). “The enduring effects of abuse and related adverse experiences in childhood: A convergence of evidence from neurobiology and epidemiology.” European Archives of Psychiatry and Clinical Neurosciences 256(3): 174-186. Andersen, J. P., et al. (2015). “Multiple early victimization experiences as a pathway to explain physical health disparities among sexual minority and heterosexual individuals.” Social Science & Medicine 133: 111-119. http://www.sciencedirect.com/science/article/pii/S0277953615001963

Brown, M. J., et al. (2015). “Sex and sexual orientation disparities in adverse childhood experiences and early age at sexual debut in the United States: Results from a nationally representative sample().” Child Abuse & Neglect 46: 89-102. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4527947/

Brown, M. J., et al. (2015). “Adverse childhood experiences and intimate partner aggression in the US: Sex differences and similarities in psychosocial mediation.” Social science & medicine (1982) 131: 48-57. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4479130/

Danese, A., et al. (2007). “Childhood maltreatment predicts adult inflammation in a life-course study.” Proceedings of the National Academy of Sciences 104(4): 1319-1324.

MIGRANT FARM WORKERS

Dube, S. R., et al. (2001). “Childhood abuse, household dysfunction, and the risk of attempted suicide throughout the life span: findings from the Adverse Childhood Experiences Study.” JAMA 286(24): 3089-3096.

Human Rights Watch, (2012). “Cultivating fear: the vulnerability of immigrant farm workers in the US to sexual violence and sexual harassment. Human Rights Watch Report.”

Felitti, V. J., et al. (1998). “Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults.” American Journal of Preventive Medicine 14(4): 245-258.

https://www.hrw.org/report/2012/05/15/cultivating-fear/

http://www.sciencedirect.com/science/article/pii/S0749379798000178

Meng, G. (May 5 2012). “The Vulnerability of Immigrant Farmworkers in the US to Sexual Violence and Sexual Harassment.”

Herman, D. B., et al. (1997). “Adverse childhood experiences: are they risk factors for adult homelessness?” American Journal of Public Health 87(2): 249-255.

https://link.springer.com/article/10.1007%2Fs10900-011-9527-7

https://www.hrw.org/report/2012/05/15/cultivating-fear/vulnerabilityimmigrant-farmworkers-us-sexual-violence-and-sexual

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1380802/

R, R. (1998). Clinical interventions with battered migrant farm worker women. Empowering Survivors of Abuse: Health Care for Battered Women and their Children. e. Campbell JC. Thousand Oaks, CA, Sage: 271-279.

Huang, H., et al. (2015). “Adverse childhood experiences and risk of type 2 diabetes: A systematic review and meta-analysis.” Metabolism 64(11): 1408-1418.

Wilson, J. B., et al. (2014). “Intimate Partner Violence Screening Among Migrant/Seasonal Farmworker Women and Healthcare: A Policy Brief.” Journal of community health 39(2): 372-377.

Meyer, I. H. (2003). “Prejudice, Social Stress, and Mental Health in Lesbian, Gay, and Bisexual Populations: Conceptual Issues and Research Evidence.” Psychological bulletin 129(5): 674-697.

https://link.springer.com/article/10.1007%2Fs10900-013-9772-z

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2072932/

Van Hightower, N. R., et al. (2000). “Predictive Models of Domestic Violence and Fear of Intimate Partners Among Migrant and Seasonal Farm Worker Women.” Journal of Family Violence 15(2): 137-154.

Korotana, L. M., et al. (2016). “A review of primary care interventions to improve health outcomes in adult survivors of adverse childhood experiences.” Clinical Psychology Review 46: 59-90.

https://link.springer.com/article/10.1023%2FA%3A1007538810858

http://www.sciencedirect.com/science/article/pii/S0026049515002528

http://www.sciencedirect.com/science/article/pii/S0272735815300295

Krause, K. D., et al. (2016). “Early Life Psychosocial Stressors and Housing Instability among Young Sexual Minority Men: the P18 Cohort Study.” Journal of Urban Health : Bulletin of the New York Academy of Medicine 93(3): 511-525. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4899333/

Nemeroff, C. B. (2004). “Neurobiological consequences of childhood trauma.” The Journal of clinical psychiatry.

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Selected Readings on Vulnerable Populations

Nurius, P. S., et al. (2012). “ACEs within a Social Disadvantage Framework: Distinguishing Unique, Cumulative, and Moderated Contributions to Adult Mental Health.” J Prev Interv Community 40(4): 278-290.

Martin-Storey, A. (2015). “Prevalence of Dating Violence Among Sexual Minority Youth: Variation Across Gender, Sexual Minority Identity and Gender of Sexual Partners.” Journal of youth and adolescence 44(1): 211-224.

Patterson, M. L., et al. (2014). “Setting the stage for chronic health problems: cumulative childhood adversity among homeless adults with mental illness in Vancouver, British Columbia.” BMC Public Health 14: 350-350.

Moracco, K. E., et al. (2005). “Knowledge and Attitudes About Intimate Partner Violence Among Immigrant Latinos in Rural North Carolina.” Violence Against Women 11(3): 337-352.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3445037/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3991866/

Roos, L. E., et al. (2013). “Relationship Between Adverse Childhood Experiences and Homelessness and the Impact of Axis I and II Disorders.” American Journal of Public Health 103(Suppl 2): S275-S281.

https://link.springer.com/article/10.1007%2Fs10964-013-0089-0

http://journals.sagepub.com/doi/10.1177/1077801204273296

Murray, C. E., et al. (2007). “Same-sex intimate partner violence: Dynamics, social context, and counseling implications.” Journal of LGBT Issues in Counseling 1(4): 7-30. Ramsay, J., et al. (2002). “Should health professionals screen women for domestic violence? Systematic review.” BMJ 325(7359): 314.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3969113/

http://www.bmj.com/content/bmj/325/7359/314.full.pdf

Schneeberger, A. R., et al. (2014). “Stressful childhood experiences and health outcomes in sexual minority populations: a systematic review.” Soc Psychiatry Psychiatr Epidemiol 49(9): 1427-1445.

Rothman, E. F., et al. (2011). “The prevalence of sexual assault against people who identify as gay, lesbian, or bisexual in the United States: A systematic review.” Trauma, Violence, & Abuse 12(2): 55-66.

https://link.springer.com/article/10.1007%2Fs00127-014-0854-8

Vernon-Feagans, L., Cox, M. J., & Conger, R. (2013). The family life project: An epidemiological and developmental study of young children living in poor rural communities. Boston, MA, Wiley. Zou, C. and J. P. Andersen (2015). “Comparing the Rates of Early Childhood Victimization across Sexual Orientations: Heterosexual, Lesbian, Gay, Bisexual, and Mostly Heterosexual.” PLoS ONE 10(10): e0139198. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4596800/

INTERPERSONAL VIOLENCE ACROSS THE LIFESPAN Anderson, M. J. (1993). “A license to abuse: The impact of conditional status on female immigrants.” The Yale Law Journal 102(6): 14011430. Balsam KF, R. E., Beauchaine TP. (2005). “Victimization over the life span: a comparison of lesbian, gay, bisexual, and heterosexual siblings.” J Consult and Clinical Psych. 73(3): 477-487. Chen, P.-H., et al. (2005). “Screening for domestic violence in a predominantly Hispanic clinical setting.” Family Practice 22(6): 617623. https://academic.oup.com/fampra/article-lookup/doi/10.1093/fampra/ cmi075

Corliss, H. L., et al. (2002). “Reports of parental maltreatment during childhood in a United States population-based survey of homosexual, bisexual, and heterosexual adults().” Child Abuse & Neglect 26(11): 1165-1178.

Tjaden P1, T. N., Allison CJ. (1999). “Comparing violence over the life span in samples of same-sex and opposite-sex cohabitants.” Violence Vict. 14(4): 413-425. Walters, M. L., Chen J., & Breiding, M.J (2013). The National Intimate Partner and Sexual Violence Survey 2010 Findings on Victimization by Sexual Orientation National Center for Injury Prevention and Control of the Centers for Disease Control and Prevention https://www.cdc.gov/violenceprevention/pdf/nisvs_sofindings.pdf

West, C. M. (2012). “Partner Abuse in Ethnic Minority and Gay, Lesbian, Bisexual, and Transgender Populations.” Partner Abuse 3(3): 336-357. http://www.ingentaconnect.com/content/springer/ pa/2012/00000003/00000003/art00003

Whitton, S. W., et al. (2016). “A Longitudinal Study of IPV Victimization Among Sexual Minority Youth.” Journal of Interpersonal Violence: 0886260516646093. http://journals.sagepub.com/doi/10.1177/0886260516646093

Widom, C. S., et al. (2014). “Child Abuse and Neglect and Intimate Partner Violence Victimization and Perpetration: A Prospective Investigation.” Child Abuse & Neglect 38(4): 650-663. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4035378/

Zou, C. and J. P. Andersen (2015). “Comparing the Rates of Early Childhood Victimization across Sexual Orientations: Heterosexual, Lesbian, Gay, Bisexual, and Mostly Heterosexual.” PLoS ONE 10(10): e0139198. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4596800/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4194076/

Edwards, K. M., Sylaska, K. M., & Neal, A. M. (2015). “Intimate Partner Violence among Sexual Minority Populations: A Critical Review of the Literature and Agenda for Future Research.” Psychology of Violence, 5(2): 112-121. Earnshaw, V. A., et al. (2016). “Bullying Among Lesbian, Gay, Bisexual, and Transgender Youth.” Pediatric Clinics of North America 63(6): 999-1010. http://www.sciencedirect.com/science/article/pii/S0031395516410564

Jonassen, J. A. and K. M. Mazor (2003). “Identification of Physician and Patient Attributes That Influence the Likelihood of Screening for Intimate Partner Violence.” Academic Medicine 78(10): S20-S23. http://journals.lww.com/academicmedicine/Fulltext/2003/10001/ Identification_of_Physician_and_Patient_Attributes.7.aspx

Selected Readings on Vulnerable Populations

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2018 CONFERENCE

Selected Readings on Vulnerable Populations by Topics for Communities of Practice

ADVERSE CHILDHOOD EXPERIENCES LGBTQ Andersen, J. P., & Blosnich, J. (2013). Disparities in Adverse Childhood Experiences among Sexual Minority and Heterosexual Adults: Results from a Multi-State Probability-Based Sample. PLoS ONE, 8(1), e54691. doi:10.1371/journal.pone.0054691 https://www.ncbi.nlm.nih.gov/pubmed/23372755

Andersen, J. P., Zou, C., & Blosnich, J. (2015). Multiple early victimization experiences as a pathway to explain physical health disparities among sexual minority and heterosexual individuals. Soc Sci Med, 133, 111-119. doi:10.1016/j.socscimed.2015.03.043 https://doi.org/10.1016/j.socscimed.2015.03.043

Austin, A., Herrick, H., & Proescholdbell, S. (2016). Adverse Childhood Experiences Related to Poor Adult Health Among Lesbian, Gay, and Bisexual Individuals. Am J Public Health, 106(2), 314-320. doi:10.2105/ ajph.2015.302904

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4596800/

HOMELESS Herman, D. B., Susser, E. S., Struening, E. L., & Link, B. L. (1997). Adverse childhood experiences: are they risk factors for adult homelessness? American Journal of Public Health, 87(2), 249-255. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1380802/

Murphy, A., Steele, H., Bate, J., Nikitiades, A., Allman, B., Bonuck, K., . . . Steele, M. (2015). Group attachment-based intervention: trauma-informed care for families with adverse childhood experiences. Fam Community Health, 38(3), 268-279. doi:10.1097/ fch.0000000000000074

https://ajph.aphapublications.org/doi/10.2105/AJPH.2015.302904

https://www.researchgate.net/publication/277411530_Group_AttachmentBased_Intervention_Trauma-Informed_Care_for_Families_With_Adverse_ Childhood_Experiences

Blosnich, J. R., & Andersen, J. P. (2015). Thursday’s child: the role of adverse childhood experiences in explaining mental health disparities among lesbian, gay, and bisexual U.S. adults. Soc Psychiatry Psychiatr Epidemiol, 50(2), 335-338. doi:10.1007/s00127014-0955-4

Patterson, M. L., Moniruzzaman, A., & Somers, J. M. (2014). Setting the stage for chronic health problems: cumulative childhood adversity among homeless adults with mental illness in Vancouver, British Columbia. BMC Public Health, 14, 350-350. doi:10.1186/1471-2458-14350

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4512235/

Clements-Nolle, K., Lensch, T., Baxa, A., Gay, C., Larson, S., & Yang, W. (2018). Sexual Identity, Adverse Childhood Experiences, and Suicidal Behaviors. J Adolesc Health, 62(2), 198-204. doi:10.1016/j. jadohealth.2017.09.022 https://www.ncbi.nlm.nih.gov/pubmed/25936843

McLaughlin, K. A., Hatzenbuehler, M. L., Xuan, Z., & Conron, K. J. (2012). Disproportionate Exposure to Early-Life Adversity and Sexual Orientation Disparities in Psychiatric Morbidity. Child Abuse & Neglect, 36(9), 645-655. doi:10.1016/j.chiabu.2012.07.004

https://bmcpublichealth.biomedcentral.com/ articles/10.1186/1471-2458-14-350

Roos, L. E., Mota, N., Afifi, T. O., Katz, L. Y., Distasio, J., & Sareen, J. (2013). Relationship between adverse childhood experiences and homelessness and the impact of axis I and II disorders. Am J Public Health, 103 Suppl 2, S275-281. doi:10.2105/ajph.2013.301323 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3969113/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3445753/

To, M. J., MacLeod, A., & Hwang, S. W. (2016). Homelessness in the Medical Curriculum: An Analysis of Case-Based Learning Content From One Canadian Medical School. Teaching and Learning in Medicine, 28(1), 35-40. doi:10.1080/10401334.2015.1108198

Meyer, I. H. (2003). Prejudice, Social Stress, and Mental Health in Lesbian, Gay, and Bisexual Populations: Conceptual Issues and Research Evidence. Psychological bulletin, 129(5), 674-697. doi:10.1037/0033-2909.129.5.674

Tsai, J., & Rosenheck, R. A. (2015). Risk Factors for Homelessness Among US Veterans. Epidemiologic reviews, 37, 177-195. doi:10.1093/ epirev/mxu004

https://www.ncbi.nlm.nih.gov/pubmed/26787083

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2072932/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4521393/

Ports, K. A., Lee, R. D., Raiford, J., Spikes, P., Manago, C., & Wheeler, D. P. (2017). Adverse Childhood Experiences and Health and Wellness Outcomes among Black Men Who Have Sex with Men. J Urban Health, 94(3), 375-383. doi:10.1007/s11524-017-0146-1

MIGRANT FARM WORKERS

https://www.ncbi.nlm.nih.gov/pubmed/28321794

Schneeberger, A. R., Dietl, M. F., Muenzenmaier, K. H., Huber, C. G., & Lang, U. E. (2014). Stressful childhood experiences and health outcomes in sexual minority populations: a systematic review. Soc Psychiatry Psychiatr Epidemiol, 49(9), 1427-1445. doi:10.1007/s00127014-0854-8 https://link.springer.com/article/10.1007/s00127-014-0854-8

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Zou, C., & Andersen, J. P. (2015). Comparing the Rates of Early Childhood Victimization across Sexual Orientations: Heterosexual, Lesbian, Gay, Bisexual, and Mostly Heterosexual. PLoS ONE, 10(10), e0139198. doi:10.1371/journal.pone.0139198

Selected Readings on Vulnerable Populations

Loria, H., & Caughy, M. (2018). Prevalence of Adverse Childhood Experiences in Low-Income Latino Immigrant and Nonimmigrant Children. J Pediatr, 192, 209-215.e201. doi:10.1016/j.jpeds.2017.09.056 https://www.deepdyve.com/lp/elsevier/prevalence-of-adverse-childhoodexperiences-in-low-income-latino-aySkxgYgy6

Migrant Clinicians Network. Toxic Stress.

https://www.migrantclinician.org/blog/2018/may/toxic-stress.html

MEDICAL EDUCATION Albaek, A. U., Kinn, L. G., & Milde, A. M. (2018). Walking Children Through a Minefield: How Professionals Experience Exploring Adverse Childhood Experiences. Qual Health Res, 28(2), 231-244. doi:10.1177/1049732317734828 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5734381/

Balistreri, K. S. (2015). Adverse Childhood Experiences, the Medical Home, and Child Well-Being. Matern Child Health J, 19(11), 2492-2500. doi:10.1007/s10995-015-1770-6 Brody, G. H., Yu, T., Chen, E., & Miller, G. E. (2017). Family-centered prevention ameliorates the association between adverse childhood experiences and prediabetes status in young black adults. Prev Med, 100, 117-122. doi:10.1016/j.ypmed.2017.04.017 https://www.ncbi.nlm.nih.gov/pubmed/28431967

Conn, A. M., Szilagyi, M. A., Jee, S. H., Manly, J. T., Briggs, R., & Szilagyi, P. G. (2017). Parental Perspectives of Screening for Adverse Childhood Experiences in Pediatric Primary Care. Fam Syst Health. doi:10.1037/fsh0000311 https://www.ncbi.nlm.nih.gov/pubmed/29215906

Felitti Md FVJ, Anda Md MSRF, Nordenberg Md D, et al. Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine. 1998;14(4):245-258.

Korotana, L. M., Dobson, K. S., Pusch, D., & Josephson, T. (2016). A review of primary care interventions to improve health outcomes in adult survivors of adverse childhood experiences. Clin Psychol Rev, 46, 59-90. doi:10.1016/j.cpr.2016.04.007 https://www.sciencedirect.com/science/article/pii/S0272735815300295

Magen, E., & DeLisser, H. M. (2017). Best Practices in Relational Skills Training for Medical Trainees and Providers: An Essential Element of Addressing Adverse Childhood Experiences and Promoting Resilience. Acad Pediatr, 17(7s), S102-s107. doi:10.1016/j. acap.2017.03.006 https://www.sciencedirect.com/science/article/pii/S1876285917301067

Marie-Mitchell, A., Studer, K. R., & O’Connor, T. G. (2016). How knowledge of adverse childhood experiences can help pediatricians prevent mental health problems. Fam Syst Health, 34(2), 128135. doi:10.1037/fsh0000179 https://www.researchgate.net/ publication/297593700_How_Knowledge_of_Adverse_Childhood_ Experiences_Can_Help_Pediatricians_Prevent_Mental_Health_ Problems https://www.researchgate.net/publication/297593700_How_Knowledge_ of_Adverse_Childhood_Experiences_Can_Help_Pediatricians_Prevent_ Mental_Health_Problems

McKelvey, L. M., Selig, J. P., & Whiteside-Mansell, L. (2017). Foundations for screening adverse childhood experiences: Exploring patterns of exposure through infancy and toddlerhood. Child Abuse Negl, 70, 112-121. doi:10.1016/j.chiabu.2017.06.002

https://www.ncbi.nlm.nih.gov/pubmed/9635069

https://www.ncbi.nlm.nih.gov/pubmed/28609691

Flynn, A. B., Fothergill, K. E., Wilcox, H. C., Coleclough, E., Horwitz, R., Ruble, A., . . . Wissow, L. S. (2015). Primary Care Interventions to Prevent or Treat Traumatic Stress in Childhood: A Systematic Review. Acad Pediatr, 15(5), 480-492. doi:10.1016/j.acap.2015.06.012

Montalvo-Liendo, N., Fredland, N., McFarlane, J., Lui, F., Koci, A. F., & Nava, A. (2015). The Intersection of Partner Violence and Adverse Childhood Experiences: Implications for Research and Clinical Practice. Issues Ment Health Nurs, 36(12), 989-1006. doi:10.3109/01612 840.2015.1074767

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4578291/

Ford, D. E. (2017). The Community and Public Well-being Model: A New Framework and Graduate Curriculum for Addressing Adverse Childhood Experiences. Acad Pediatr, 17(7s), S9-s11. doi:10.1016/j. acap.2017.04.011 https://www.academicpedsjnl.net/article/S1876-2859(17)30167-5/abstract

Forstadt, L., Cooper, S., & Andrews, S. M. (2015). Changing Medicine and Building Community: Maine’s Adverse Childhood Experiences Momentum. Perm J, 19(2), 92-95. doi:10.7812/tpp/14-169 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4403584/

Glowa, P. T., Olson, A. L., & Johnson, D. J. (2016). Screening for Adverse Childhood Experiences in a Family Medicine Setting: A Feasibility Study. J Am Board Fam Med, 29(3), 303-307. doi:10.3122/ jabfm.2016.03.150310 https://www.ncbi.nlm.nih.gov/m/pubmed/27170787/

Goldstein, E., Athale, N., Sciolla, A. F., & Catz, S. L. (2017). Patient Preferences for Discussing Childhood Trauma in Primary Care. Perm J, 21. doi:10.7812/tpp/16-055 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5363895/

Goldstein, E., Murray-Garcia, J., Sciolla, A. F., & Topitzes, J. (2018). Medical Students’ Perspectives on Trauma-Informed Care Training. Perm J, 22. doi:10.7812/tpp/17-126 https://www.ncbi.nlm.nih.gov/pubmed/29401053

Kerker, B. D., Storfer-Isser, A., Szilagyi, M., Stein, R. E., Garner, A. S., O’Connor, K. G., . . . Horwitz, S. M. (2016). Do Pediatricians Ask About Adverse Childhood Experiences in Pediatric Primary Care? Acad Pediatr, 16(2), 154-160. doi:10.1016/j.acap.2015.08.002 https://www.aap.org/en-us/Documents/journals_research_update.pdf

https://www.tandfonline.com/doi/abs/10.3109/01612840.2015.1074767

Oh, D. L., Jerman, P., Silverio Marques, S., Koita, K., Purewal Boparai, S. K., Burke Harris, N., & Bucci, M. (2018). Systematic review of pediatric health outcomes associated with childhood adversity. BMC Pediatr, 18(1), 83. doi:10.1186/s12887-018-1037-7 http://pediatrics.aappublications.org/content/141/1_MeetingAbstract/309

Olsen, J. M., & Warring, S. L. (2018). Interprofessional Education on Adverse Childhood Experiences for Associate Degree Nursing Students. J Nurs Educ, 57(2), 101-105. doi:10.3928/0148483420180123-07 https://www.ncbi.nlm.nih.gov/pubmed/29384571

Stefanski, K., & Mason, K. (2017). Acing education: pilot curriculum on adverse childhood experiences. Med Educ, 51(11), 1167-1168. doi:10.1111/medu.13436 https://onlinelibrary.wiley.com/doi/full/10.1111/medu.13436

Strait, J., & Bolman, T. (2017). Consideration of Personal Adverse Childhood Experiences during Implementation of TraumaInformed Care Curriculum in Graduate Health Programs. Perm J, 21. doi:10.7812/tpp/16-061 http://www.thepermanentejournal.org/issues/2017/6238-ACE.html

Szilagyi, M., Kerker, B. D., Storfer-Isser, A., Stein, R. E., Garner, A., O’Connor, K. G., . . . McCue Horwitz, S. (2016). Factors Associated With Whether Pediatricians Inquire About Parents’ Adverse Childhood Experiences. Acad Pediatr, 16(7), 668-675. doi:10.1016/j. acap.2016.04.013

https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S1876285916301 486?returnurl=https:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii %2FS1876285916301486%3Fshowall%3Dtrue&referrer=https:%2F%2Fwww. ncbi.nlm.nih.gov%2F

Selected Readings on Vulnerable Populations

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Tink, W., Tink, J. C., Turin, T. C., & Kelly, M. (2017). Adverse Childhood Experiences: Survey of Resident Practice, Knowledge, and Attitude. Fam Med, 49(1), 7-13. https://www.ncbi.nlm.nih.gov/pubmed/28166574

Traub, F., & Boynton-Jarrett, R. (2017). Modifiable Resilience Factors to Childhood Adversity for Clinical Pediatric Practice. Pediatrics, 139(5). doi:10.1542/peds.2016-2569 http://pediatrics.aappublications.org/content/early/2017/04/17/peds.20162569

Vega-Arce, M., & Nunez-Ulloa, G. (2017). [Screening of adverse childhood experiences in preschoolers: scoping review]. Bol Med Hosp Infant Mex, 74(6), 385-396. doi:10.1016/j.bmhimx.2017.07.003 https://www.sciencedirect.com/science/article/pii/ S1665114617300989?via%3Dihub

Wade, R., Jr., Becker, B. D., Bevans, K. B., Ford, D. C., & Forrest, C. B. (2017). Development and Evaluation of a Short Adverse Childhood Experiences Measure. Am J Prev Med, 52(2), 163-172. doi:10.1016/j. amepre.2016.09.033 https://www.sciencedirect.com/science/article/pii/ S0749379716304998?via%3Dihub

Wen, F. K., Miller-Cribbs, J. E., Coon, K. A., Jelley, M. J., & FoulksRodriguez, K. A. (2017). A simulation and video-based training program to address adverse childhood experiences. Int J Psychiatry Med, 52(3), 255-264. doi:10.1177/0091217417730289 http://journals.sagepub.com/doi/ abs/10.1177/0091217417730289?journalCode=ijpb

TRAUMA INFORMED CARE Cohen, J. A., Berliner, L., & Mannarino, A. (2010). Trauma focused CBT for children with co-occurring trauma and behavior problems. Child Abuse & Neglect, 34(4), 215-224. doi:http://dx.doi.org/10.1016/j. chiabu.2009.12.003 https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S01452134100 00517?returnurl=https:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii %2FS0145213410000517%3Fshowall%3Dtrue&referrer=https:%2F%2F www.ncbi.nlm.nih.gov%2F

Cohen, J. A., Mannarino, A. P., & Murray, L. K. (2011). Traumafocused CBT for youth who experience ongoing traumas. Child Abuse & Neglect, 35(8), 637-646. doi:http://dx.doi.org/10.1016/j. chiabu.2011.05.002 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3171639/

Ellis, W. R., & Dietz, W. H. (2017). A New Framework for Addressing Adverse Childhood and Community Experiences: The Building Community Resilience Model. Acad Pediatr, 17(7s), S86-s93. doi:10.1016/j.acap.2016.12.011

https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S18762859163 05526?returnurl=https:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii %2FS1876285916305526%3Fshowall%3Dtrue&referrer=https:%2F%2F www.ncbi.nlm.nih.gov%2F

Finkelhor, D. (2017). Screening for adverse childhood experiences (ACEs): Cautions and suggestions. Child Abuse Negl. doi:10.1016/j. chiabu.2017.07.016

https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S01452134173 02715?returnurl=https:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii %2FS0145213417302715%3Fshowall%3Dtrue&referrer=https:%2F%2F www.ncbi.nlm.nih.gov%2F

Finkelhor, D., Shattuck, A., Turner, H., & Hamby, S. (2015). A revised inventory of Adverse Childhood Experiences. Child Abuse Negl, 48, 13-21. doi:10.1016/j.chiabu.2015.07.011 https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S01452134150 02409?returnurl=https:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii %2FS0145213415002409%3Fshowall%3Dtrue&referrer=https:%2F%2F www.ncbi.nlm.nih.gov%2F

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Selected Readings on Vulnerable Populations

Green, B. L., Saunders, P. A., Power, E., Dass-Brailsford, P., Schelbert, K. B., Giller, E., . . . Mete, M. (2015). Trauma-Informed Medical Care: A CME Communication Training for Primary Care Providers. Family medicine, 47(1), 7-14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4316735/

Leitch, L. (2017). Action steps using ACEs and trauma-informed care: a resilience model. Health Justice, 5(1), 5. doi:10.1186/s40352-0170050-5 https://healthandjusticejournal.springeropen.com/articles/10.1186/s40352017-0050-5

Marsac, M. L., Kassam-Adams, N., Hildenbrand, A. K., Nicholls, E., Winston, F. K., Leff, S. S., & Fein, J. (2016). Implementing a TraumaInformed Approach in Pediatric Healthcare Networks. JAMA Pediatrics, 170(1), 70-77. doi:10.1001/jamapediatrics.2015.2206 https://jamanetwork.com/journals/jamapediatrics/fullarticle/2470861

Murphy, A., Steele, H., Bate, J., Nikitiades, A., Allman, B., Bonuck, K., . . . Steele, M. (2015). Group attachment-based intervention: trauma-informed care for families with adverse childhood experiences. Fam Community Health, 38(3), 268-279. doi:10.1097/ fch.0000000000000074 https://www.ncbi.nlm.nih.gov/pubmed/26017004

Oral, R., Ramirez, M., Coohey, C., Nakada, S., Walz, A., Kuntz, A., . . . Peek-Asa, C. (2016). Adverse childhood experiences and trauma informed care: the future of health care. Pediatr Res, 79(1-2), 227-233. doi:10.1038/pr.2015.197 https://www.nature.com/articles/pr2015197

Pachter, L. M., Lieberman, L., Bloom, S. L., & Fein, J. A. (2017). Developing a Community-Wide Initiative to Address Childhood Adversity and Toxic Stress: A Case Study of The Philadelphia ACE Task Force. Acad Pediatr, 17(7s), S130-s135. doi:10.1016/j.acap.2017.04.012 https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S18762859173 01687?returnurl=https:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii %2FS1876285917301687%3Fshowall%3Dtrue&referrer=https:%2F%2F www.ncbi.nlm.nih.gov%2F

Raja, S., Hoersch, M., Rajagopalan, C. F., & Chang, P. (2014). Treating patients with traumatic life experiences: Providing trauma-informed care. The Journal of the American Dental Association, 145(3), 238245. doi:https://doi.org/10.14219/jada.2013.30 https://www.sciencedirect.com/science/article/pii/ S0002817714600593?via%3Dihub

Schilling, S., Fortin, K., & Forkey, H. (2015). Medical Management and Trauma-Informed Care for Children in Foster Care. Current Problems in Pediatric and Adolescent Health Care, 45(10), 298-305. doi:http:// dx.doi.org/10.1016/j.cppeds.2015.08.004 https://www.cppah.com/article/S1538-5442(15)00102-9/abstract

Sperlich, M., Seng, J. S., Li, Y., Taylor, J., & Bradbury-Jones, C. (2017). Integrating Trauma-Informed Care Into Maternity Care Practice: Conceptual and Practical Issues. J Midwifery Womens Health, 62(6), 661-672. doi:10.1111/jmwh.12674 https://onlinelibrary.wiley.com/doi/abs/10.1111/jmwh.12674

Weinstein, Wolin, & Rose. (2014). Trauma Informed Community Building A Model for Strengthening Community in Trauma Affected Neighborhoods. https://healthequity.sfsu.edu/content/white-paper-model-strengtheningcommunity-trauma-affected-neighborhoods

INTERPERSONAL VIOLENCE ACROSS THE LIFE COURSE LGBTQ Ard, K. L., & Makadon, H. J. (2011). Addressing Intimate Partner Violence in Lesbian, Gay, Bisexual, and Transgender Patients. Journal of General Internal Medicine, 26(8), 930-933. doi:10.1007/s11606-0111697-6 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3138983/

Baker, N. L., Buick, J. D., Kim, S. R., Moniz, S., & Nava, K. L. (2013). Lessons from Examining Same-Sex Intimate Partner Violence. Sex Roles, 69(3), 182-192. doi:10.1007/s11199-012-0218-3

Freedner, N., Freed, L. H., Yang, Y. W., & Austin, S. B. (2002). Dating violence among gay, lesbian, and bisexual adolescents: results from a community survey. Journal of Adolescent Health, 31(6), 469-474. doi:http://dx.doi.org/10.1016/S1054-139X(02)00407-X https://www.ncbi.nlm.nih.gov/pubmed/12457580

Han, S. C., Gallagher, M. W., Franz, M. R., Chen, M. S., Cabral, F. M., & Marx, B. P. (2013). Childhood Sexual Abuse, Alcohol Use, and PTSD Symptoms as Predictors of Adult Sexual Assault Among Lesbians and Gay Men. Journal of Interpersonal Violence, 28(12), 2505-2520. doi:10.1177/0886260513479030

https://link.springer.com/article/10.1007%2Fs11199-012-0218-3

http://journals.sagepub.com/doi/ abs/10.1177/0886260513479030?journalCode=jiva

Balsam, K. F., Rothblum, E. D., & Beauchaine, T. P. (2005). Victimization Over the Life Span: A Comparison of Lesbian, Gay, Bisexual, and Heterosexual Siblings. Journal of Consulting and Clinical Psychology, 73(3), 477-487. doi:10.1037/0022-006X.73.3.477

Heintz, A. J., & Melendez, R. M. (2006). Intimate Partner Violence and HIV/STD Risk Among Lesbian, Gay, Bisexual, and Transgender Individuals. Journal of Interpersonal Violence, 21(2), 193-208. doi:10.1177/0886260505282104

http://psycnet.apa.org/doiLanding?doi=10.1037%2F0022-006X.73.3.477

http://journals.sagepub.com/doi/abs/10.1177/0886260505282104

Blain, L. M., Muench, F., Morgenstern, J., & Parsons, J. T. (2012). Exploring the role of child sexual abuse and posttraumatic stress disorder symptoms in gay and bisexual men reporting compulsive sexual behavior. Child Abuse & Neglect, 36(5), 413-422. doi:http:// dx.doi.org/10.1016/j.chiabu.2012.03.003

Hughes, T., McCabe, S. E., Wilsnack, S. C., West, B. T., & Boyd, C. J. (2010). Victimization and substance use disorders in a national sample of heterosexual and sexual minority women and men. Addiction (Abingdon, England), 105(12), 2130-2140. doi:10.1111/j.13600443.2010.03088.x

https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S01452134120 00774?returnurl=https:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii %2FS0145213412000774%3Fshowall%3Dtrue&referrer=https:%2F%2F www.ncbi.nlm.nih.gov%2F

Burke, T. W., Jordan, M. L., & Owen, S. S. (2002). A cross-national comparison of gay and lesbian domestic violence. Journal of Contemporary Criminal Justice, 18(3), 231-257. http://journals.sagepub.com/doi/ abs/10.1177/1043986202018003003?journalCode=ccja

Corliss, H. L., Cochran, S. D., & Mays, V. M. (2002). Reports of parental maltreatment during childhood in a United States population-based survey of homosexual, bisexual, and heterosexual adults(). Child Abuse & Neglect, 26(11), 1165-1178. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4194076/

Dank, M., Lachman, P., Zweig, J. M., & Yahner, J. (2014). Dating Violence Experiences of Lesbian, Gay, Bisexual, and Transgender Youth. Journal of youth and adolescence, 43(5), 846-857. doi:10.1007/ s10964-013-9975-8 https://link.springer.com/article/10.1007%2Fs10964-013-9975-8

Earnshaw, V. A., Bogart, L. M., Poteat, V. P., Reisner, S. L., & Schuster, M. A. (2016). Bullying Among Lesbian, Gay, Bisexual, and Transgender Youth. Pediatric Clinics of North America, 63(6), 999-1010. doi:http:// dx.doi.org/10.1016/j.pcl.2016.07.004 https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S00313955164 10564?returnurl=https:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii %2FS0031395516410564%3Fshowall%3Dtrue&referrer=https:%2F%2F www.ncbi.nlm.nih.gov%2F

Elze, D. E. (2003). Gay, lesbian, and bisexual youths’ perceptions of their high school environments and comfort in school. Children & Schools, 25(4), 225-239.

https://academic.oup.com/cs/article-abstract/25/4/225/567363?redirectedF rom=fulltext

Frankland, A., & Brown, J. (2014). Coercive Control in Same-Sex Intimate Partner Violence. Journal of Family Violence, 29(1), 15-22. doi:10.1007/s10896-013-9558-1

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3006226/

Kosciw, J. G., Greytak, E. A., & Diaz, E. M. (2009). Who, What, Where, When, and Why: Demographic and Ecological Factors Contributing to Hostile School Climate for Lesbian, Gay, Bisexual, and Transgender Youth. Journal of youth and adolescence, 38(7), 976-988. doi:10.1007/ s10964-009-9412-1 https://link.springer.com/article/10.1007%2Fs10964-009-9412-1

McKenry, P. C., Serovich, J. M., Mason, T. L., & Mosack, K. (2006). Perpetration of gay and lesbian partner violence: A disempowerment perspective. Journal of Family Violence, 21(4), 233-243. https://link.springer.com/article/10.1007%2Fs10896-006-9020-8

Murray, C. E., Mobley, A. K., Buford, A. P., & Seaman-DeJohn, M. M. (2007). Same-sex intimate partner violence: Dynamics, social context, and counseling implications. Journal of LGBT Issues in Counseling, 1(4), 7-30. https://libres.uncg.edu/ir/uncg/f/AK_Mobley_Same_2007.pdf

Pilkington, N. W., & D’Augelli, A. R. (1995). Victimization of lesbian, gay, and bisexual youth in community settings. Journal of Community Psychology, 23(1), 34-56. https://onlinelibrary.wiley.com/doi/full/10.1002/15206629%28199501%2923%3A1%3C34%3A%3AAIDJCOP2290230105%3E3.0.CO%3B2-N

Roberts, A. L., Austin, S. B., Corliss, H. L., Vandermorris, A. K., & Koenen, K. C. (2010). Pervasive Trauma Exposure Among US Sexual Orientation Minority Adults and Risk of Posttraumatic Stress Disorder. American Journal of Public Health, 100(12), 2433-2441. doi:10.2105/AJPH.2009.168971 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2978167/

Rothman, E. F., Exner, D., & Baughman, A. L. (2011). The prevalence of sexual assault against people who identify as gay, lesbian, or bisexual in the United States: A systematic review. Trauma, Violence, & Abuse, 12(2), 55-66. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3118668/

https://link.springer.com/article/10.1007/s10896-013-9558-1

Selected Readings on Vulnerable Populations

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West, C. M. (2012). Partner Abuse in Ethnic Minority and Gay, Lesbian, Bisexual, and Transgender Populations. Partner Abuse, 3(3), 336-357. doi:10.1891/1946-6560.3.3.336 Whitton, S. W., Newcomb, M. E., Messinger, A. M., Byck, G., & Mustanski, B. (2016). A Longitudinal Study of IPV Victimization Among Sexual Minority Youth. Journal of Interpersonal Violence, 0886260516646093. doi:10.1177/0886260516646093 http://journals.sagepub.com/doi/ abs/10.1177/0886260516646093?journalCode=jiva

Zou, C., & Andersen, J. P. (2015). Comparing the Rates of Early Childhood Victimization across Sexual Orientations: Heterosexual, Lesbian, Gay, Bisexual, and Mostly Heterosexual. PLoS ONE, 10(10), e0139198. doi:10.1371/journal.pone.0139198 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4596800/

HOMELESS Baker, C. K., Billhardt, K. A., Warren, J., Rollins, C., & Glass, N. E. (2010). Domestic violence, housing instability, and homelessness: A review of housing policies and program practices for meeting the needs of survivors. Aggression and Violent Behavior, 15(6), 430-439. https://www.ncjrs.gov/App/Publications/abstract.aspx?ID=254945

Crawford, D. M., Whitbeck, L. B., & Hoyt, D. R. (2011). Propensity for Violence among Homeless and Runaway Adolescents: An Event History Analysis*. Crime and delinquency, 57(6), 950-968. doi:10.1177/0011128709335100 http://journals.sagepub.com/doi/ abs/10.1177/0011128709335100?journalCode=cadc

Ferguson, K. M. (2008). Exploring Family Environment Characteristics and Multiple Abuse Experiences Among Homeless Youth. Journal of Interpersonal Violence, 24(11), 1875-1891. doi:10.1177/0886260508325490 http://journals.sagepub.com/doi/10.1177/0886260508325490

Heerde, J. A., & Hemphill, S. A. (2015). Sexual Risk Behaviors, Sexual Offenses, and Sexual Victimization Among Homeless Youth. Trauma, Violence, & Abuse, 17(5), 468-489. doi:10.1177/1524838015584371 http://journals.sagepub.com/doi/ abs/10.1177/1524838015584371?journalCode=tvaa

Petering, R. (2016). Sexual Risk, Substance Use, Mental Health, and Trauma Experiences of Gang-Involved Homeless Youth. Journal of Adolescence, 48, 73-81. doi:10.1016/j.adolescence.2016.01.009 https://linkinghub.elsevier.com/retrieve/pii/S0140197116000208

Petering, R., Rhoades, H., Rice, E., & Yoshioka-Maxwell, A. (2015). Bidirectional Intimate Partner Violence and Drug Use Among Homeless Youth. Journal of Interpersonal Violence, 32(14), 2209-2217. doi:10.1177/0886260515593298 http://journals.sagepub.com/doi/ abs/10.1177/0886260515593298?journalCode=jiva

Petering, R., Rhoades, H., Winetrobe, H., Dent, D., & Rice, E. (2017). Violence, Trauma, Mental Health, and Substance Use Among Homeless Youth Juggalos. Child Psychiatry & Human Development, 48(4), 642-650. doi:10.1007/s10578-016-0689-5 https://link.springer.com/article/10.1007/s10578-016-0689-5

Petering, R., Rice, E., Rhoades, H., & Winetrobe, H. (2014). The Social Networks of Homeless Youth Experiencing Intimate Partner Violence. Journal of Interpersonal Violence, 29(12), 2172-2191. doi:10.1177/0886260513516864 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4490129/

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Selected Readings on Vulnerable Populations

Ponce, A. N., Lawless, M. S., & Rowe, M. (2014). Homelessness, Behavioral Health Disorders and Intimate Partner Violence: Barriers to Services for Women. Community Mental Health Journal, 50(7), 831-840. doi:10.1007/s10597-014-9712-0 https://link.springer.com/article/10.1007%2Fs10597-014-9712-0

Slesnick, N., Erdem, G., Collins, J., Patton, R., & Buettner, C. (2010). Prevalence of Intimate Partner Violence Reported by Homeless Youth in Columbus, Ohio. Journal of Interpersonal Violence, 25(9), 1579-1593. doi:10.1177/0886260509354590 http://journals.sagepub.com/doi/10.1177/0886260509354590

Sullivan, C. M., Bomsta, H. D., & Hacskaylo, M. A. (2016). Flexible Funding as a Promising Strategy to Prevent Homelessness for Survivors of Intimate Partner Violence. Journal of Interpersonal Violence, 0886260516664318. doi:10.1177/0886260516664318 http://journals.sagepub.com/doi/abs/10.1177/0886260516664318

Tsai, A. C., Weiser, S. D., Dilworth, S. E., Shumway, M., & Riley, E. D. (2015). Violent Victimization, Mental Health, and Service Utilization Outcomes in a Cohort of Homeless and Unstably Housed Women Living With or at Risk of Becoming Infected With HIV. American Journal of Epidemiology, 181(10), 817-826. doi:10.1093/aje/kwu350 https://academic.oup.com/aje/article/181/10/817/158568

Tyler, K. A., Whitbeck, L. B., Hoyt, D. R., & Cauce, A. M. (2004). Risk Factors for Sexual Victimization Among Male and Female Homeless and Runaway Youth. Journal of Interpersonal Violence, 19(5), 503520. doi:10.1177/0886260504262961 http://journals.sagepub.com/doi/10.1177/0886260504262961

Vijayaraghavan, M., Tochterman, A., Hsu, E., Johnson, K., Marcus, S., & Caton, C. L. M. (2012). Health, Access to Health Care, and Health Care use Among Homeless Women with a History of Intimate Partner Violence. Journal of community health, 37(5), 1032-1039. doi:10.1007/ s10900-011-9527-7 https://link.springer.com/article/10.1007%2Fs10900-011-9527-7

MIGRANT FARM WORKERS Chen, P.-H., Rovi, S., Vega, M., Jacobs, A., & Johnson, M. S. (2005). Screening for domestic violence in a predominantly Hispanic clinical setting. Family Practice, 22(6), 617-623. doi:10.1093/fampra/cmi075 https://academic.oup.com/fampra/article/22/6/617/497968

Kim-Godwin YS1, F. J. (2009). Gender differences in intimate partner violence and alcohol use among Latino-migrant and seasonal farmworkers in rural southeastern North Carolina. J Community Health Nurs., 26(3), 131-142. https://www.tandfonline.com/doi/abs/10.1080/07370010903034474

Kim-Godwin, Y. S., Maume, M. O., & Fox, J. A. (2014). Depression, Stress, and Intimate Partner Violence Among Latino Migrant and Seasonal Farmworkers in Rural Southeastern North Carolina. Journal of Immigrant and Minority Health, 16(6), 1217-1224. doi:10.1007/ s10903-014-0007-x https://link.springer.com/article/10.1007%2Fs10903-014-0007-x

Kugel, C., Retzlaff, C., Hopfer, S., Lawson, D. M., Daley, E., Drewes, C., & Freedman, S. (2009). Familias con Voz: Community Survey Results from an Intimate Partner Violence (IPV) Prevention Project with Migrant Workers. Journal of Family Violence, 24(8), 649-660. doi:10.1007/s10896-009-9263-2 https://link.springer.com/article/10.1007/s10896-009-9263-2

Larson, O. W., Doris, J., & Alvarez, W. F. (1987). Child maltreatment among U.S. east coast migrant farm workers. Child Abuse & Neglect, 11(2), 281-291. doi:http://dx.doi.org/10.1016/0145-2134(87)90068-8 https://www.ncbi.nlm.nih.gov/pubmed/3496144

Lopez, M. J., Mintle, R. A., Smith, S., Garcia, A., Torres, V. N., Keough, A., & Salgado, H. (2015). Risk Factors for Intimate Partner Violence in a Migrant Farmworker Community in Baja California, MĂŠxico. Journal of Immigrant and Minority Health, 17(6), 1819-1825. doi:10.1007/ s10903-014-9988-8 https://link.springer.com/article/10.1007%2Fs10903-014-9988-8

Martin, S. L., Gordon, T. E., & Kupersmidt, J. B. (1995). Survey of exposure to violence among the children of migrant and seasonal farm workers. Public Health Reports, 110(3), 268-276. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1382117/

Moracco, K. E., Hilton, A., Hodges, K. G., & Frasier, P. Y. (2005). Knowledge and Attitudes About Intimate Partner Violence Among Immigrant Latinos in Rural North Carolina. Violence Against Women, 11(3), 337-352. doi:10.1177/1077801204273296 http://journals.sagepub.com/doi/10.1177/1077801204273296

R, R. (1998). Clinical interventions with battered migrant farm worker women. In e. Campbell JC (Ed.), Empowering Survivors of Abuse: Health Care for Battered Women and their Children. (pp. 271-279). Thousand Oaks, CA: Sage. Short LM, R. R. (2002). Testing an intimate partner violence assessment icon form with battered migrant and seasonal farmworker women. Women Health, 35(2-3), 181-192. https://www.ncbi.nlm.nih.gov/pubmed/12201507

Van Hightower, N. R., Gorton, J., & DeMoss, C. L. (2000). Predictive Models of Domestic Violence and Fear of Intimate Partners Among Migrant and Seasonal Farm Worker Women. Journal of Family Violence, 15(2), 137-154. doi:10.1023/A:1007538810858 https://link.springer.com/article/10.1023/A:1007538810858

Watch, H. R. (2012). Cultivating fear: the vulnerability of immigrant farm workers in the US to sexual violence and sexual harassment. Human Rights Watch Report, . Retrieved from https://www.hrw. org/report/2012/05/15/cultivating-fear/

MEDICAL EDUCATION Rich-Edwards JW, Mason S, Rexrode K, et al. Physical and sexual abuse in childhood as predictors of early onset cardiovascular events in women. Circulation. 2012;126(8):920-927. 11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3649533/

Suglia SF, Sapra KJ, Koenen KC. Violence and Cardiovascular Health: A Systematic Review. American journal of preventive medicine. 2015;48(2):205-212. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4300436/

Duncan AE, Auslander WF, Bucholz KK, Hudson DL, Stein RI, White NH. Relationship Between Abuse and Neglect in Childhood and Diabetes in Adulthood: Differential Effects By Sex, National Longitudinal Study of Adolescent Health. Preventing chronic disease. 2015;12:E70. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4436043/

Khan A, McCormack HC, Bolger EA, et al. Childhood Maltreatment, Depression, and Suicidal Ideation: Critical Importance of Parental and Peer Emotional Abuse during Developmental Sensitive Periods in Males and Females. Frontiers in psychiatry. 2015;6:42. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378368/

Kohl K, Gross I, Harrison P, Richards M. Numbing and Hyperarousal as Mediators of Exposure to Community Violence and Depression in Urban African-American Youth. Journ Child Adol Trauma. 2015;8(1):33-43. https://link.springer.com/article/10.1007/s40653-015-0038-z

Stringhini S, Batty GD, Bovet P, et al. Association of Lifecourse Socioeconomic Status with Chronic Inflammation and Type 2 Diabetes Risk: The Whitehall II Prospective Cohort Study. PLoS Medicine. 2013;10(7):e1001479. https://doi.org/10.1371/journal.pmed.1001479

Turner HA, Shattuck A, Finkelhor D, Hamby S. Polyvictimization and Youth Violence Exposure Across Contexts. Journal of Adolescent Health.n2016 Feb;58(2):208-14. https://doi.org/10.1016/j.jadohealth.2015.09.021

https://www.hrw.org/report/2012/05/15/cultivating-fear/vulnerabilityimmigrant-farmworkers-us-sexual-violence-and-sexual

Wilson, J. B., Rappleyea, D. L., Hodgson, J. L., Brimhall, A. S., Hall, T. L., & Thompson, A. P. (2016). Healthcare providers’ experiences screening for intimate partner violence among migrant and seasonal farmworking women: A phenomenological study. Health Expectations : An International Journal of Public Participation in Health Care and Health Policy, 19(6), 1277-1289. doi:10.1111/hex.12421 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5139058/

Wilson, J. B., Rappleyea, D. L., Hodgson, J. L., Hall, T. L., & White, M. B. (2014). Intimate Partner Violence Screening Among Migrant/ Seasonal Farmworker Women and Healthcare: A Policy Brief. Journal of community health, 39(2), 372-377. doi:10.1007/s10900-013-9772-z https://link.springer.com/article/10.1007%2Fs10900-013-9772-z

Selected Readings on Vulnerable Populations

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2017 ONLINE RESOURCES Articles, guidelines, reviews, etc.

https://www.dropbox.com/sh/7bs9ibwwmsw8fmn/AACKhUVqJKASKXQPcicLrXAAa?dl=0

2018 ONLINE RESOURCES Toolkit, Presentations, YouTube videos, and more.

https://drive.google.com/drive/folders/1h-knlkptPYAB9I6wFJjNO_EGXFkgKGpY?usp=sharing

Enhancing primary care training for health care professionals to improve the quality of health for vulnerable populations http://NCMEDR.org

The Primary Care Training and Enhancement Academic Units (AU) project is supported in part through a cooperative agreement (UH1HP30348) with the US Department of Health and Human Services (DHHS)/ Health Resources and Services Administration (HRSA) and Department of Family and Community Medicine, School of Medicine, Meharry Medical College. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by DHHS, HRSA or the U.S. Government.

Conference Secretariat 1Joshua Group, LLC http://the1joshuagroup.com