Papers by Katie Davis
Background: We evaluated the influence of prenatal exposure to widespread urban air pollutants on... more Background: We evaluated the influence of prenatal exposure to widespread urban air pollutants on the development of self-regulation and social competence in a longitudinal prospective cohort of children born to nonsmoking minority women in New York City. Methods: Air pollutant exposure was estimated categorically by level of polycyclic aromatic hydrocarbon (PAH)-DNA adducts in maternal blood collected at delivery, providing a biomarker of maternal exposure to PAH over a 2-to 3-month period. Deficient emotional self-regulation (DESR) was defined as moderate elevations on three specific scales of the child behavior checklist (anxious/depressed, aggressive behavior, and attention problems). We used generalized estimating equations to assess the influence of prenatal exposure to PAH on DESR in children at 3–5, 7, 9, and 11 years of age, adjusted for gender and race/ethnicity. Next, we assessed the association of prenatal exposure to PAH with social competence, as measured by the social responsiveness scale (SRS), the association of impaired self-regulation with social competence, and whether impairment in self-regulation mediated the association of prenatal exposure to PAH with social competence. Results: We detected a significant interaction (at p = .05) of exposure with time, in which the developmental trajectory of self-regulatory capacity was delayed in the exposed children. Multiple linear regression revealed a positive association between presence of PAH-DNA adducts and problems with social competence (p < .04), level of dysregulation and problems with social competence (p < .0001), and evidence that self-regulation mediates the association of prenatal exposure to PAH with social competence (p < .0007). Conclusions: These data suggest that prenatal exposure to PAH produces long-lasting effects on self-regulatory capacities across early and middle childhood, and that these deficits point to emerging social problems with real-world consequences for high-risk adolescent behaviors in this minority urban cohort.
PURPOSE Although the US adolescent pregnancy rate is high, use of the most effective reversible ... more PURPOSE Although the US adolescent pregnancy rate is high, use of the most effective reversible contraceptives—intrauterine devices (IUDs) and implantable contraception—is low. Increasing use of long-acting reversible contraception (LARC) could decrease adolescent pregnancy rates. We explored New York City primary care physicians’ experiences, attitudes, and beliefs about counseling and provision of LARC to adolescents.
METHODS We conducted in-depth telephone interviews with 28 family physi- cians, pediatricians, and obstetrician-gynecologists using an interview guide based on an implementation science theoretical framework. After an iterative coding and analytic process, findings were interpreted using the capability (knowledge and skills), opportunity (environmental factors), and motivation (atti- tudes and beliefs) conceptual model of behavior change.
RESULTS Enablers to IUD counseling and provision include knowledge that nul- liparous adolescents are appropriate IUD candidates (capability) and opportunity factors, such as (1) a clinical environment supportive of adolescent contraception, (2) IUD availability in clinic, and (3) the ability to insert IUDs or easy access to
an someone who can. Factors enabling motivation include belief in the overall positive consequences of IUD use; this is particularly influenced by a physicians’ perception of adolescents’ risk of pregnancy and sexually transmitted disease. Physicians rarely counsel about implantable contraception because of knowledge gaps (capability) and limited access to the device (opportunity).
CONCLUSION Knowledge, skills, clinical environment, and physician attitudes, all influence the likelihood a physician will counsel or insert LARC for adolescents. Interventions to increase adolescents’ access to LARC in primary care must be tailored to individual clinical practice sites and practicing physicians, the methods must be made more affordable, and residency programs should offer up-to-date, evidence-based teaching.
Conference Presentations by Katie Davis
Increasing use of IUC could decrease adolescent pregnancy rates. This study explored New York Cit... more Increasing use of IUC could decrease adolescent pregnancy rates. This study explored New York City school-based health care providers’ experiences, attitudes, and beliefs about IUC counseling for adolescents. Eight school-based health care providers were interviewed with a semi-structured interview guide based on an implementation science theoretical framework. The interviews were analyzed according to a grounded theory approach. Facilitators and barriers to counseling were identified, and findings were interpreted using a model that explains clinical behavior change: the Capability, Opportunity, and Motivation-Behavior Change model. Facilitators to IUC counseling include knowledge that nulliparous adolescents are appropriate IUC candidates (capability) and opportunity factors, such as a clinical environment supportive of adolescent contraception, IUC inserter availability in clinic, and health educator availability in clinic. Factors enabling motivation include belief in the overall positive consequences of IUC use; this is particularly influenced by a provider’s past experience counseling adolescents for IUC. School-based health care settings are structured in a way that is ideal for IUC counseling. Knowledge, skills, clinical environment, and provider attitudes all influence the likelihood that a provider will counsel IUC for adolescents. Interventions to increase counseling for IUC in school-based settings must be geared primarily at adequately staffing clinics and making IUC more readily available for insertion.
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Papers by Katie Davis
METHODS We conducted in-depth telephone interviews with 28 family physi- cians, pediatricians, and obstetrician-gynecologists using an interview guide based on an implementation science theoretical framework. After an iterative coding and analytic process, findings were interpreted using the capability (knowledge and skills), opportunity (environmental factors), and motivation (atti- tudes and beliefs) conceptual model of behavior change.
RESULTS Enablers to IUD counseling and provision include knowledge that nul- liparous adolescents are appropriate IUD candidates (capability) and opportunity factors, such as (1) a clinical environment supportive of adolescent contraception, (2) IUD availability in clinic, and (3) the ability to insert IUDs or easy access to
an someone who can. Factors enabling motivation include belief in the overall positive consequences of IUD use; this is particularly influenced by a physicians’ perception of adolescents’ risk of pregnancy and sexually transmitted disease. Physicians rarely counsel about implantable contraception because of knowledge gaps (capability) and limited access to the device (opportunity).
CONCLUSION Knowledge, skills, clinical environment, and physician attitudes, all influence the likelihood a physician will counsel or insert LARC for adolescents. Interventions to increase adolescents’ access to LARC in primary care must be tailored to individual clinical practice sites and practicing physicians, the methods must be made more affordable, and residency programs should offer up-to-date, evidence-based teaching.
Conference Presentations by Katie Davis
METHODS We conducted in-depth telephone interviews with 28 family physi- cians, pediatricians, and obstetrician-gynecologists using an interview guide based on an implementation science theoretical framework. After an iterative coding and analytic process, findings were interpreted using the capability (knowledge and skills), opportunity (environmental factors), and motivation (atti- tudes and beliefs) conceptual model of behavior change.
RESULTS Enablers to IUD counseling and provision include knowledge that nul- liparous adolescents are appropriate IUD candidates (capability) and opportunity factors, such as (1) a clinical environment supportive of adolescent contraception, (2) IUD availability in clinic, and (3) the ability to insert IUDs or easy access to
an someone who can. Factors enabling motivation include belief in the overall positive consequences of IUD use; this is particularly influenced by a physicians’ perception of adolescents’ risk of pregnancy and sexually transmitted disease. Physicians rarely counsel about implantable contraception because of knowledge gaps (capability) and limited access to the device (opportunity).
CONCLUSION Knowledge, skills, clinical environment, and physician attitudes, all influence the likelihood a physician will counsel or insert LARC for adolescents. Interventions to increase adolescents’ access to LARC in primary care must be tailored to individual clinical practice sites and practicing physicians, the methods must be made more affordable, and residency programs should offer up-to-date, evidence-based teaching.