Policy Perspective: Sexual Health Education
A recent Los Angeles Times article discusses the recent cancellation of federal grant funding to the state of California for sexual education over what the administration deems "radical gender ideology". The funding helps pay for sex education programs in juvenile justice facilities, homeless shelters and foster care group homes, as well as some schools, reaching an estimated 13,000 youths per year through 20 agencies.
Several IHPS faculty contribute to the evidence base on adolescent sexual health education. Mara Decker, DrPH, and colleagues have looked at ways to target hard to reach populations for sexual education. They looked at school-based, comprehensive sexual health education, an important strategy for addressing the needs of youth in rural communities. They found comprehensive sexual health education can be successfully implemented with Latino youth in rural communities, with evidence of strong attendance, program satisfaction, and positive change in short-term outcomes.
Jennifer Yarger, PhD, along with Mara Decker, DrPH, and colleagues studied integrating digital technologies into sexual health education, which can offer advantages for connecting with adolescents, particularly populations who may be underserved through common school-based approaches. Their study findings show the potential for incorporating user-centered design and technology into sexual health education to better support adolescents who may have limited access to this important information.
| | IHPS FACULTY SPOTLIGHT CONVERSATION | | |
"For the policy audience I'm trying to quantify trends that are affecting the workforce in terms of physicians. Are physicians leaving the workforce? Are they spending less time caring for patients? And, what is the time that it takes them to care for patients to ensure that we are appropriately paying for that time and supporting that time?"
Dr. Rotenstein is a primary care physician, researcher and healthcare leader whose work focuses on ambulatory care delivery, the physician workforce, and the intersection of the electronic health record with these issues. Dr. Rotenstein's research on the electronic health record (EHR), published in JAMA Internal Medicine, JAMA Network Open, JAMIA, and more, has deepened our understanding of the role of the EHR in influencing the physician experience, as well as how novel technologies such as virtual and AI scribes can shape physician workflows. Her scholarship on the physician workforce, published in JAMA, JAMA Internal Medicine, JAMA Health Forum, and the Journal of General Internal Medicine has fostered increased awareness of the epidemic of physician burnout, its predictors, and potential solutions. Finally, she is a nationally recognized expert on primary care delivery and trends, with her research and writing on this topic featured in the New England Journal of Medicine, the Harvard Business Review, and JAMA Internal Medicine.
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What are you currently working on?
One of my current projects is about the roles of paraprofessionals in organizations in the Bay Area that provide behavioral health services to Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPI). The project team includes Professor Chuan Mei Lee, a faculty member in the Department of Psychiatry and Behavioral Sciences who is affiliated with IHPS, and Amy Quan, a research associate at IHPS. The goals of the project are to describe the roles that paraprofessionals play in serving AANHPIs with behavioral health needs and develop a framework for evaluating their impact on the well-being of the clients they serve.
What drew you to work on this?
I have studied the health care workforce throughout my career and have always been interested in innovations in the roles of health care workers and access to care for diverse populations. Amy and I previously completed a project on the roles of paraprofessionals in behavioral health in general and saw this project as an opportunity to build on that work to look more closely at paraprofessionals who serve AANHPIs. People in these racial/ethnic groups are less likely to seek help from licensed behavioral clinicians than other racial/ethnic groups and are not as well-represented among licensed clinicians. We wanted to understand the ways in which organizations that serve AANHPIs with behavioral health needs are utilizing paraprofessionals to help bridge these gaps. This work is also deeply personal to me because I struggle with my own mental health.
What's next?
We anticipate releasing a report during the first quarter of 2026. After the report is released, we hope to use the evaluation framework we are developing to partner with an organization that serves AANHPIs with behavioral health needs to evaluate the impact of their paraprofessionals on access to services and the well-being of their clients.
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What are you currently working on?
I am developing a pediatric clinic–based intervention to support postpartum health. I am conducting iterative interviews and focus groups with postpartum individuals and pediatric and obstetric clinicians to incorporate their preferences into the intervention design. The intervention will be implemented and pilot tested in pediatric primary care clinics in the Bay Area and Central Valley during 2026–2027.
What drew you to this work?
As a general pediatrician, I see how new parents prioritize the care of their babies, sometimes at the expense of their own health and health care. This can be especially true for parents facing multiple barriers to accessing care. I have long wondered how pediatric clinics could better support new parents and ease access to care during the postpartum months, with the ultimate goal of promoting the health and wellbeing of the whole family.
What’s next?
I am preparing to launch two collaborative projects with national pediatric research networks. First, through the Better Outcomes through Research for Newborns (BORN) Network, I am preparing to launch a study on U.S. birth hospital practices related to the care of newborns with prenatal substance exposure. Second, in collaboration with Pediatric Emergency Care Applied Research Network (PECARN) and Pediatric Emergency Research Canada (PERC), I will be examining pediatric emergency department practices for substance use screening and initiation of medications for opioid use disorder. This work is laying the groundwork for the development of a clinical practice guideline for pediatric clinicians.
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Naomi Bardach, MD, and colleagues published "Pediatric Leaders' Perspectives on Climate Change Advocacy", in the Academic Pediatrics. Pediatric leaders regard climate advocacy as an important role for pediatricians who wish to promote health equity and child and family health. In the first qualitative exploration of United States pediatrician perspectives on climate change policy advocacy, they share their findings that explore advocacy's importance for mitigating climate change's impacts on pediatric health and may guide future interventions to enhance pediatricians' advocacy engagement.
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Anil Makam, MD, MAS, and colleague, Rashmita Basu, PhD, published "Did Site-Neutral Payment for Long-Term Care Hospitals Reduce Financial Incentives to Time Discharge?", in the Journal of the American Medical Directors Association. Historically, fee-for-service Medicare reimbursed long-term care hospital (LTCH) stays as a lump-sum payment, which was substantially reduced for discharges before the diagnosis-specific short-stay outlier (SSO) threshold day, leading to large spikes in discharges on the threshold day. They found unwarranted spikes in discharge on the SSO threshold persisted despite a 50% reduction in the payment increase, a crucial insight for policymakers and payers who seek to avoid incentives to strategically time discharges. LTCH stays should be reimbursed without meaningful payment increases based on length of stay thresholds.
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Lisa Rotenstein, MD, MBA, Christopher Toretsky, MPH, Elaine Khoong, MD, MS, Urmimala Sarkar, MD and Julia Adler-Milstein, PhD, published "Appointment Density, Message Responsiveness, and Patient Satisfaction", in JAMA Network Open. Clinicians’ responsiveness to patient needs is associated with patient satisfaction, an important dimension of quality of care. This study looked at how physician responsiveness to messages sent via the electronic health record (EHR) and appointment density are associated with patient satisfaction.
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Nhung Nguyen, PhD, PharmD, Pamela Ling, MD, MPH, Salomeh Keyhani, MD, and colleagues published "Real-Time Antecedents of Young Adults' Vaping and Co-Vaping of Nicotine and Cannabis: An Ecological Momentary Assessment Study" in the Journal of Medical Internet Research. Nicotine and cannabis vaping are common among young adults and can potentially lead to adverse health consequences. Identifying real-time antecedents of vaping events may provide insights into intervention targets pertinent to these behaviors. They found similar antecedents (craving and alcohol use) and unique antecedents (mood, advertising exposure, and time of day) for nicotine vaping, cannabis vaping, and same-occasion co-vaping, suggesting targets for future vaping cessation interventions.
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Benjamin Rosner:
(Medscape)
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Philip R. Lee Fellowship Fund | Since its founding 50 years ago, IHPS has been dedicated to training the next generation of leaders in interdisciplinary research to solve our most important health policy issues. In celebration of our 50th anniversary and to honor our founders, Phil Lee and Lew Butler, we established an endowment fund for the Philip R. Lee Fellowship. We hope to continue to keep this fund and our fellowship program robust. | Photo: Kim Felder Rhoads, MD, MS, MPH & Fellow for 2007-2008 with Philip R. Lee, MD, Founder of the Institute for Health Policy Studies |
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