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Child and Adolescent Health

Research and Practice

The work of faculty in the child and adolescent health area of interest extends to education and training, research, practice and policy. The areas of interest may be grouped into the following areas:

  • Early Childhood Services and Systems
  • Children and Youth with Special Health Care Needs (CYSHCN)
  • Child Health Measurement
  • Policies to Promote Child Health
  • Child Development
  • Early Life Origins of Disease
  • Women's, Infants and Children (WIC) Program
  • Maternal and Child Health
  • Adolescent Health
  • Intesections of youth, health, and criminal justice

Early Childhood Systems

Promoting the Cycle of Engagement Between the Family and the Provider

Christina Bethell, Narangerel Gombojav
The Cycle of Engagement (COE) is a model of parent-centered care for well-child visits in pediatrics to improve quality and outcomes of all aspects in well-child care. COE tools are web-based, parent-centered, and consist of the Well-Visit Planner (WVP) for pre-visit planning and the Online Promoting Healthy Development Survey (Online PHDS) for post-visit assessment of quality of care given.
Learn more at the Cycle of Engagement.

Early Childhood Home Visiting Applied Research Collaborative

Anne Duggan, Kay O’Neill, Cynthia Minkovitz, and Allison West
The Home Visiting Applied Research Collaborative (HARC) is a research and development platform that aims to intensify the use of breakthrough impact research methods to address national home visiting priorities around home visiting precision and impact among at-risk families and communities and to accelerate translation of research results into practice.
Learn more at Home Visiting Research Network.

Evaluation of New Jersey’s Project LAUNCH

Cynthia Minkovitz, Anne Duggan
Project Launch promotes a comprehensive, coordinated health system to address the physical, emotional, social, behavioral, and cognitive aspects of child wellness from pregnancy to age eight using evidence based practices. (Completed)

Evidence-Based Early Home Visiting for Parents with Intellectual Disabilities

Allison West
Evidence-based maternal and early childhood home visiting is a promising strategy to improve outcomes for children of parents with intellectual disabilities and other learning difficulties. The aims of this national study are to 1) evaluate current practices for addressing the needs of parents with learning diffciulties, and 2) assess multi-level factors associated with variability in practices.

Examining Early Childhood Teachers’ and Children’s Executive Functioning

Sara Johnson, Lieny Jeon
This study investigates the role of early childhood education teachers’ cognitive self-regulation skills in shaping these skills in their students, including opportunities to scaffold teacher skills to improve child functioning and achievement. Spencer Foundation.

Mother and Infant Home Visiting Program Evaluation

Anne Duggan, Cynthia Minkovitz, Kay O'Neill
National multi-site randomized trial and implementation study of evidence-based home visiting through DHHS's Maternal, Infant and Early Childhood Home Visiting Program. The study assesses impacts on intended outcomes, multi-level factors for service delivery, and program features that moderate impacts.


Identification of Exosomal MicroRNA Markers of Maternal Distress and Offspring Metabolic Health using the PREDICT cohort

Sara Johnson, Kellie Tamashiro, Neil Goldenberg
This pilot grant seeks to understand whether exposure to maternal distress during pregnancy is reflected in changes in the circulating exosome miRNA profile and predicts risk for negative metabolic health conditions, such as diabetes and obesity, in offspring.

Social Adversity, Epigenetics and the Obesity Epidemic

Sara Johnson
This project leverages the Johns Hopkins All Children’s Hospital PREDICT study to evaluate epigenetic mediators of the relationship between maternal lifetime and pregnancy- specific adversity and the early development of obesity in her offspring.

The Oral Microbiome in Early Life and Autism-Related Phenotypes

Sara Johnson, Heather Volk, Robert Yoken
This pilot grant is designed to evaluate the relationship of both the maternal prenatal oral microbiome and the child oral microbiome and autism-related phenotypes in the PREDICT cohort. Wendy Klag Center for Autism & Developmental Disabilities.

Research to Strengthen Home Visiting Impact on Parental Engagement in Children's Education

Anne Duggan, Allison West, Kay O’Neill
This project’s main objective is to adapt and test a set of observational research measures of home visitor – family communication. We have used these observational measures to code over 200 videos of actual home visits and have developed a toolkit to help home visitors and supervisors use them in their daily practice.

Statewide Evaluations of Early Childhood Home Visiting Programs in Maryland and New Jersey

Maryland: Allison West and Anne Duggan | New Jersey: Anne Duggan and Cynthia Minkovitz, Anne Lilly
Utilization-focused evaluative research to increase the accessibility, effectiveness, efficiency, coordination, quality and impact of home visiting in improving outcomes and reducing health and developmental disparities of at-risk expectant families and families with young children.

Using Stakeholder-driven Research to Strengthen Coordination of Health and Human Services to Advance Early Childhood Care for Vulnerable Families

Cynthia Minkovitz, Anne Duggan, Allison West
Research to advance the building of early childhood systems of care for vulnerable families by strengthening the role of home visiting in coordinating health and human services. This project develops a framework for coordination, creates a set of indicators to measure its achievement, and assesses the extent of coordination at the state and local levels.

Children and Youth With Special Health Care Needs (CYSHCN)

CARE_PATH for Kids Model and Tools

Christina Bethell, Salvia Zeeshan, Mary Wahl
The CARE_PATH for Kids (CPK) is a 3-step whole child approach for families of children and youth with special health care needs to engage, plan, and imrove care planning and outcomes in partnership with their child’s care team(s).
Learn more at CARE_PATH.

Evaluation of Improving Services for Children and Youth with ASD/DD

Cynthia Minkovitz, Kristin Mmari (evaluators for Parents Place)
The goal of this project is to improve services for children and youth with autism spectrum disorder (ASD) and other developmental disabilities (DD) in the state of Maryland. (Completed)

Child Health Measurement

Maternal Child Health Measurement Research Network

Christina Bethell
(2016-2020) Supported by HRSA’s Maternal and Child Health Bureau, the Measurement Research Network (MRN) is a multidisciplinary, collaborative network of experts who represent the MCH lifespan and who are active in the measurement of health and well-being of MCH populations. Its purpose is to provide a sustainable platform to inspire, support, coordinate, and advance efforts related to MCH measurement, measurement innovation, and shared accountability to improve outcomes and systems performance on behalf of the nation’s children, youth, and families. The MRN has designed a measurement framework and agenda dedicated to supporting, coordinating, and advancing efforts related to MCH measurement, measurement innovation, and shared accountability. One of the most notable features of the MRN is the “MRN Measurement Compendium,” which provides over 1000 MCH measures from 11 different measure sets; its purpose is to allow users to quickly browse all by measure set, data source category, and/or 3 levels of topical categories.

Learn more at the MCH Measurement Research Network.

The National Data Resource Center for Child and Adolescent Health (DRC)

Christina Bethell, Narangerel Gombojav
(2018-2023) Supported by HRSA’s Maternal and Child Health Bureau, the purpose of the National Maternal and Child Health Data Resource Initiative (DRI) is to make available National Survey of Children’s Health (NSCH) findings at the national, regional, and state level through our online, user-friendly Interactive Data Query, downloadable data set features, and other website resources. Additionally, the DRI supports Title V Maternal and Child Health Service Block Grant programs and partners in accessing and effectively utilizing data from each level.
Learn more at the National Data Resource Center.

Policies to Promote Child Health

Building on the Momentum for Trauma-Responsive Policies and Approaches to Promote Thriving and Healing among vulnerable and diverse Californians

Christina Bethell
With support from The California Endowment, Dr. Bethell is working to promote trauma and ACEs screening in California. In 2019, California Governor Gavin Newsom set aside Marijuana Expenditures from Proposition 64 in order to fund this effort within the state. Dr. Bethell has explored and researched ways to best apply these expenditures to properly distribute them among those who need it most.

Learn more at California Prop 64 Expenditures.

Cookshop Longitudinal Evaluation

Kristin Mmari, Beth Marshall, Susan Gross, MaryCatherine Augustyn, David Paige
To examine the impact of a nutrition education program, Cookshop, on the knowledge, attitudes, and behaviors in regards to healthy eating among low-income elementary school students and their parents in New York City. (Completed)

District Splitting in Uganda

David Bishai
This study looks at the impact on health system performance from Uganda’s policy of decentralizing control and splitting districts. (Completed)

Feeding Baltimore’s Children: The Impact of Community Eligibility

Susan Gross, Anne Palmer, Marycatherine Augustyn
The project collected and analyzed data from the Maryland State Department of Education to determine if implementation of the Community Eligibility Provision (CEP) in City Schools has a quantifiable impact on the rate of: school meal participation; meals served; absenteeism; tardiness; academic achievement; and school advancement and graduation. In addition, through surveys, the project worked to determine if implementation of CEP had an impact on food insecurity rates among families with children attending Baltimore City Public Schools. Principal responsibilities included project management, data analysis, and report and manuscript preparation. (Completed)

The Impact of Waivers on Summer Meal Participation in Maryland

Susan M. Gross, Marycatherine Augustyn
The aim of this study is to assess the impact of the change in USDA Summer Food Service Program waiver regulations on summer meal participation rates and provider participation in selected school districts in Maryland. Principal Responsibilities as the principal investigator include supervision of data management and analysis, project monitoring and manuscript writing.

Maryland Prenatal to Age Three Initiative

Cynthia Minkovitz, Allison West
Develop a robust prenatal-to-age-three policy agenda and action plan in Maryland focused on expanding statewide access to high quality programs designed to support children’s healthy development and build a strong foundation.

Payment for Progress: Investing to Catalyze Child and Family Well-Being Using Personalized and Integrated Strategies to Address Social and Emotional Determinants of Health

Christina Bethell
This project is built on prior work led by CAHMI and AcademyHealth to develop a framework, measures, data, knowledge, capacity and consensus in the field to advance a national agenda for promoting child and family well-being by addressing the social and emotional determinants of health (SEDH) and ACEs in children’s health services. Publication.

Step Wedge Trial of Crèches and Play Pens to Prevent Child Drowning in Bangladesh

David Bishai, Natalia Alfonso
This study will compare injury rates and child developmental outcomes among children exposed and unexposed to crèche-type day care and the introduction of play pens in rural Bangladesh. (Completed)

Strengthen the Evidence Base for Maternal and Child Health Programs

Cynthia Minkovitz, Donna Strobino, Holly Grason, Susan Gross
This project provides support and resources to assist State Title V MCH programs in incorporating available scientific evidence in developing State Action Plans and responding to national and state performance measures.
Learn more at, and visit the MCH Digital Library.

Using Census Data on State Public Health Spending to Identify State Policies tied to Lower IMR

David Bishai
This study examines 25 years of data on state spending on health, state spending on hospitals and Medicaid spending to assess the association of spending to infant mortality. (Completed)

Child Development

Evaluation of the Knit to Quit Program in Baltimore City (Sponsor: Lerner Center for Health Promotion)

Allison West
Despite robust evidence linking perinatal tobacco exposure with poor maternal and child outcomes, a majority of pregnant women receiving opioid maintenance medication treatment smoke cigarettes. B’more for Healthy Babies (BHB) and the Baltimore City Health Department (BCHD) designed Knit to Quit, a group intervention to support smoking cessation among clients and staff at local substance use disorder treatment and recovery programs serving women of reproductive age. The model integrates psychoeducation and motivational messaging within a semi-structured group knitting class to improve participants’ knowledge, self-efficacy, and motivation to quit, increase social support for quitting, reduce stress, and, ultimately, reduce tobacco use. The goal of this project is to evaluate implementation and effectiveness of the Knit to Quit intervention.

Fetus to Five

Sara Johnson
Study of social influences on self-regulatory development from the prenatal period to age 5. (Completed)

Leveraging Progress to Advance Knowledge, Data and Resources to Build a Culture of Health for Children Youth and Families

Christina Bethell, Narangerel Gombojav
(2018-2020) One of the core foundations of the CAHMI has been to build resilience and overall support for children who have experienced trauma and adverse childhood experiences (ACEs). With funding from the Robert Wood Johnson Foundation, CAHMI is committed to RWJF’s goal of “Creating a Culture of Health” by focusing on research promoting whole child, person, and population well-being, through policy and practice.

New Jersey Preschool Development Grant Birth through Age Five

Cynthia Minkovitz, Anne Duggan, Anne Lilly
This two-generational approach promotes a comprehensive, coordinated early childhood system of care to address the physical, social-emotional, behavioral cognitive aspects of child wellbeing and school readiness from prenatal through age five.

Understanding and Promoting Language Development in Young Children in Baltimore City

Sara Johnson, Tracy King, Megan Bair-Merritt
Study of the role of maternal psychosocial distress on language development in very low-SES families, and piloting on novel language processing technology (LENA). (Completed)

Early Life Origins of Disease

To learn more, visit the Center on Early Life Origins of Disease.

Early Life Determinants of Autism Spectrum Disorders and other Developmental Disabilities

Xiaobin Wang, Dani Fallin, Li-ching Lee, Anne Riley, Rebecca Landa, Mei-Cheng Wang, Yuelong Ji, Xiumei Hong, Guoying Wang, Nilanjan Chatterjee, Tak Igusa, and faculty at Boston Medical Center
The goal is to investigate preconception, pre- and peri-natal risk factors and diagnostic and service patterns for ASD in a prospective birth cohort.

Early Life Determinants of Obesity in U.S. Urban Low-Income Minority Birth Cohort

Xiaobin Wang, Bruce Lee, Tina Cheng, Sally Radovick, Xiumei Hong, Guoying Wang, Hongkai Ji, and faculty at Boston Medical Center
The major goals of this project are to identify early life risk and protective factors for obesity development; explore the mediating effect of the epigenome; and to develop predictive models.

Inter-generational Link of Cardio-Metabolic Risk: Integrate Multi-OMICs with Birth Cohort

Xiaobin Wang, Tina Cheng, Guoying Wang, Xiumei Hong, and faculty at Harvard
To investigate the inter-generational link of cardio-metabolic outcomes and explore epigenetic underpinnings in the Boston Birth Cohort.

In Utero Exposure to Metals and Vitamins B on Placenta and Child Cardiometabolic Outcomes

Guoying Wang, Xiaobin Wang, Irina Burd, Hongkai Ji
This project investigates the effect of maternal exposure to toxic metals/trace elements and Vitamin B status on placental pathology and child cardio-metabolic outcomes.

Maternal Stress and Preterm Birth: Role of Genome and Epigenome

Xiumei Hong, Xiaobin Wang, Pam Surkan, Winnie Tang, Hongkai Ji, Irina Burd
The major goal of this project is to investigate the interactions of maternal stress and maternal genome on risk of preterm birth (PTB); and the role of the maternal epigenome in mediating gene – stress interaction on PTB risk.

Prenatal Multi-Level Stressors and Alterations in Maternal and Fetal Epigenomes

Xiaobin Wang, Pam Surkan, Winnie Tang, Xiumei Hong, Hongkai Ji, and other faculty at BSPH, SOM and Boston Medical Center
We aim to test the hypothesis that maternal psychosocial stressors can affect maternal and offspring DNA methylation profiles that is detectable at birth in the Boston Birth Cohort.

Preterm Birth, Maternal and Cord Blood Metabolome, and Child Metabolic Risk

Xiaobin Wang, Frank Hu, Xiumei Hong, Guoying Wang, Irina Burd, Sally Radovick, Hongkai Ji, and other faculty at BSPH, SOM, Harvard, MIT and Boston Medical Center
This study aims to investigate whether prematurity and maternal and fetal metabolic characteristics can jointly affect the future development of child adverse metabolic outcomes in the Boston Birth Cohort.

Women's, Infants and Children (WIC) Program

The USDA Johns Hopkins University Women, Infants and Children’s Program (WIC)

​David Paige, Susan Gross, Marycatherine Augustyn
WIC provides nutrition education, healthy supplemental foods and referral services to over 10,000 low income women, infants and children in Maryland. Services are provided at 12 clinic locations and numerous community locations, including shelters for the homeless, victims of domestic abuse and Head Start Centers in Baltimore. The program is by the Maryland Department of Health and Mental Hygiene through the funding of the United States Department of Agriculture. While the WIC Program is at its core a nutrition program focused on improving the nutrition and health of Maryland’s most vulnerable residents, there are numerous associated studies and projects. These include efforts to promote and support breastfeeding, as well as studies that address reducing maternal obesity, providing residents with the tools to make healthy food choices and improving healthy food access in Baltimore City.
Learn more at WIC.

Hopkins Participant Research Innovations Laboratory for Enhancing WIC Services (HPRIL)

David Paige, Laura Caulfield, Susan Gross, Marycatherine Augustyn
The overall study objective is to improve participation and retention of children 1-4 years of age. JHU will select up to five WIC local agencies (LA) as sub-grantees and provide training, technical assistance and evaluation.
Learn more at HPRIL.

Adolescent Health 

The ABC Study

Jenny Robinson, Maria Trent, Jean Anderson, Anne Burke
This study explores the contraceptive knowledge, attitudes, and choices of adolescent women living with HIV.

Addressing Transportation as a Social Determinant of Health: Improving Adolescent Access to Services Using the JH HUBLyft Services

Maria Trent
Baltimore, Maryland is a large city whose adolescents and emerging adults face significant health disparities, but engagement in routine health visits for receipt of preventive and health maintenance services declines during this period. Transportation is a major limitation for adolescent health-seeking behaviors and adherence for recommended follow-up visits. In Baltimore, these issues are compounded for low-income youth as Baltimore’s bus and rail system is limited making travel to routine health care visits time-consuming and cumbersome. Further, Baltimore is characterized as one of the most dangerous cities in America and the rates of violent crime in the few miles surrounding the Johns Hopkins Children’s Center is substantial. The Johns Hopkins University School of Medicine is currently offering the highly successful JH SafeRide program in collaboration with Lyft that ensures adult medical students can reach campus and move about the community safely. This proposal seeks to increase adolescent engagement in care by developing health transportation accounts for local teenagers receiving primary care at the Johns Hopkins Center for Adolescent and Young Adult Health (CAYAH) at Harriet Lane to afford them the same opportunities we give to our Hopkins students to reach campus safely for health visits.

Adolescent Reproductive Health Promotion Training Program

Maria Trent
The primary training objectives and goals for this training period are to assist trainees in developing skills in the diagnosis, management, and treatment of the unique medical and psychosocial problems of adolescence and young adulthood, development of significant and innovative research questions using interdisciplinary study designs, development of a primary research study, implementation of a primary research study, secondary data analysis, and development of a grant application.

Better Together

Terrinieka Powell
Better Together is a multiphase project that takes a community approach to reducing substance use among African American adolescents in Baltimore through partnerships with Black churches. There are three phases to this project. First, qualitative methods will be used to better understand interactions and experiences of youth with a drug-abusing parent. Second, we will develop an evidence-based intervention to be appropriate for youth with a drug-using parent. Finally, I will conduct a pilot test of the intervention in partnership with schools and churches in Baltimore City.

cART Adherence in YLHIV: TECH-N-2-CHECK IN

Maria Trent
Human immunodeficiency virus (HIV) infection has disproportionately persisted as a public health threat to adolescents and young adults (AYA) from minority communities in the United States. HIV has evolved into a chronic disease, which can be managed in the outpatient setting with antiretroviral therapy (ART) designed to achieve virologic suppression and life expectancy equivalent for uninfected individuals. However, for AYA, huge disparities exist compared to adults, with greater proportions unaware of their status, lower rates of care engagement, retention, and initiation and maintenance of ART, resulting in higher rates of virologic non- suppression, and development of sequelae including immunologic deterioration and transmission. Interventions designed to improve outcomes for youth living with HIV (YLHIV) are being sponsored by agencies including the Centers for Disease Control and Prevention and the National Institutes of Health, however, most target the early components of the continuum of care (identification, linkage, and ART initiation). Our research from the HIV Research Network shows that 30-40% of YLHIV are not virologically suppressed despite being in care, highlighting the need for novel interventions targeting the distal components of the care continuum. Community health nurse (CHN) interventions have been shown to increase access to appropriate resources, enhance health care utilization, and promote risk-reducing behavior among AYA. Use of short messaging service (SMS) messaging can further enhance clinical care by improving attendance at medical visits, medication adherence, and communication with the health care team. We have used these two modalities in randomized trials of youth with complex sexually transmitted infections (STIs) in low-income minority communities with high feasibility and acceptability amongst AYA and their families, remarkable improvements in visit completion, medication adherence, and reduction in recurrent STIs. The overarching goal of this project is to build on the evidence from this trial and to repurpose the intervention for YLHIV in the same community who are having challenges with care and medication non-adherence. We aim to compare the effectiveness of a technology-enhanced community health nursing intervention (TECH-N 2 CHECK-IN) to a standard of care control group using a randomized trial design. The central hypothesis is that the intervention will result in higher rates of adherence to ART and virologic suppression. We have demonstrated our interdisciplinary team's capacity to follow urban AYA in the community, utilizing the combination of CHNs and outreach workers to optimize care according to national standards. TECH-IN 2 CHECK-IN aims to enroll 120 YLHIV followed at clinics specializing in HIV care in the Baltimore-Washington Metropolitan area who are challenged with treatment adherence and randomizing them to receive TECH-IN 2 CHECK-IN vs. standard of care. Results of this trial will inform best practices for engaging YLHIV by addressing the distal component of the continuum, critical to achieving the elusive 90-90-90 HIV goals.

Developing a Dyadic Intervention for STI/HIV Prevention among STI-Affected Youth

Maria Trent
While public health programs have demonstrated modest success in reducing the adolescent and young adult (AYA) risk for STI/HIV, significant health disparities remain. The risk of STI/HIV is not uniform among AYA. AYA residing in segregated urban communities with high STI prevalence and complicated sexual networks face even greater risk for disease and associated complications. Additional supports designed to increase engagement in care and reduce STI acquisition and transmissions are urgently needed to meet the sexual health and reproductive health goals for the nation. Overwhelmingly, AYA STI prevention interventions have targeted individuals and individual-level factors. While effective, these interventions do not adequately address other important influences affecting AYA risk for STI/HIV, such as partner or relationship influences on sexual decision-making and behavior. Partner notification and treatment is a key strategy for disease control and has previously been tested among adults for STI/HIV prevention work but has yet to be evaluated for AYA. Our prior research demonstrates that AYAs with complicated STIs are likely to notify their partners to seek treatment (88-92%); however, AYAs receiving brief behavioral interventions, relative to those receiving standard of care were 3 times more likely to be successful in arranging for their partner's treatment. Thus, partner interventions may hold promise for harnessing the power of relationship dynamics to enhance sexual decision-making, communication, and subsequent health behaviors. We propose to pilot test an intervention designed to change sexual health outcomes by understanding partners and the learning environment related to sex [COUPLES] by simultaneously delivering two evidence-based STI/HIV prevention interventions Sister- to-Sister Teen and Focus on the Future. The simultaneous delivery of effective interventions will be augmented with a joint partner health education counseling session focused on enhancing communication and negotiation of safe sexual practices within the relationship. If successful, this pilot will support the development of a larger trial designed to evaluate the effectiveness of this approach in the busy primary care setting by providing evidence that AYA can and will safely engage their partners in a supportive primary care setting that integrates high quality treatment with evidence-based STI/HIV prevention interventions delivered by health educator teams.

Developing and Evaluating Life Skills Training Plus

Terrinieka Powell, Phil Leaf, Beth Marshall
This study was the core research project of the Center for Adolescent Health from 2014 - 2019. Through this project, we developed and evaluated the impact of additional Life Skills Training Modules focused on sexual risk taking on the risk behaviors and academic outcomes of Baltimore City middle school students. Additionally, neighborhood and other contextual data were examined the variability in program impact. (Complete)

Early Adolescent Sexual and Reproductive Needs in Refugee Settings

Courtland Robinson
The study explores sexual and reproductive health needs and risks of very young adolescents (10-14) in humanitarian contexts; unaccompanied and separated children in emergencies. The current research takes place in refugee camps and displaced persons settlements at the Thai-Burma and at the Ethopia-Somalia borders. It is a collaboration with the International Refugee Committee’s Womens Refugee Commission.

Effect of Injectable Contraceptives on Inflammation, Microbiota, and STI/HIV Risk Among Adolescents using Injectable Contraceptives

Maria Trent
Adolescent girls and young women who use injectable progestin contraceptives without barrier protection are at risk of acquiring an STI, including HIV. The proposed research is relevant to public health because it seeks to understand the interaction between hormonal contraception, vaginal microbiota, and inflammation that may increase STI/HIVsusceptibility. This knowledge is critical to help inform biomedical interventions to prevent STI/HIV acquisition among adolescent girls and young women.

Evaluation of Sexual Health Curriculum for Health Students in Tanzania

Maria Trent
As documented in the US Surgeon General's Call to Action to Promote Sexual Health and Responsible Sexual Behavior, training of health providers in sexual health care is critical to addressing a broad array of the nation's sexual and reproductive health concerns. Yet rigorous trials evaluating the effects of sexual health curricula on provider behavior are rare. In sub-Saharan Africa, an environment which has the highest rates of HIV, STI, teen pregnancy, unwanted pregnancy, unsafe abortion, child marriage of girls and sexual assault of boys in the world, and where female genital cutting, wife-beating, marital rape, criminalization of homosexuality, stigmatization of Lesbian, Gay, Bisexual and Transgender (LGBT) persons, myths about masturbation leading to dysfunction, and rates of sexual dysfunction in both men and women are common, we could find no formalized training of health providers in sexual health care. Sexual health education, even of health providers, is a sensitive issue in Africa. Consequently, a rigorous study of its effects is needed, if such education is to be widely adopted. Recently, at Muhimbili University of Health and Allied Sciences (MUHAS) in Dar es Salaam, we adapted a PAHO/WHO sexual health curriculum training for healthcare providers for implementation in Tanzania. Participants were 87 nursing, midwifery, and allied health science students. Pre-post evaluations show the curriculum to be highly acceptable, needed, and desired by students, feasible in implementation, and effective in improving student knowledge, attitudes, and skills in providing sexual health care to patients. The logical next step in this line of research is to conduct the first rigorous trial of a comprehensive sexual health training curriculum for health professionals in Tanzania. There are three specific aims. Aim 1 is to conduct a social ecological needs assessment of sexual health care delivery in Tanzania. To determine whether midwifery, nursing, medical, and allied health science students would benefit from one curriculum or separate curricula tailored by discipline, we will conduct focus groups (3 from each discipline). We will also conduct individual interviews with key informants to address structural and cultural issues. In Aim 2, we will further adapt our curriculum, ensure it is culturally tailored to the Tanzanian/sub-Saharan context, and pilot test it. Aim 3 is to evaluate the effectiveness of an African-based, culturally-appropriate, sexual health curriculum. We will conduct a randomized, controlled, single blinded trial of the curriculum against a waitlist control assessing effects on sexual health knowledge, attitudes, and counseling skills (n=206 students per arm; 412 in total). Hypotheses will test if the curriculum is effective, and whether it is more effective for one discipline than another. If effective, MUHAS has committed to implement the curriculum for all their health students. Given MUHAS is preeminent in health student education across Africa, the curriculum assessed in this study has high potential to be widely adopted as a new standard of training for health professionals across Africa.

Faith-based Adolescents Involved in Total Health

Terrinieka Powell, Sam Illangasekare
Focused on those areas of Baltimore where the adolescent pregnancy rates are the highest, this study aims to understand what is currently being done in the churches of those communities to address pregnancy prevention and to identify the potentials and barriers for effective interventions. (Complete)

The Global Early Adolescent Study

Robert Blum, Caroline Moreau, Kristin Mmari, Saifuddin Ahmed, Lori Heise, Leah Keonig, Mengmeng Li, Mark Emerson
The Global Early Adolescent Study (GEAS) seeks to understand how norms, attitudes and expectations about gender influence health outcomes and behaviors across the adolescent period. Building upon formative, mixed-methods research conducted in sixteen countries between 2014 and 2016, the GEAS has collected baseline data from over 13,000 adolescents on five continents since 2017. Additional survey topics include sexual and reproductive health, mental health, body comfort, school retention and empowerment. In four countries, the GEAS is used to evaluate the longitudinal impact of gender-transformative interventions carried out by Rutgers, Netherlands; Save the Children and the Institute of Women and Ethnic Studies. Participating GEAS sites include New Orleans, USA; Cuenca, Ecuador; Santiago, Chile; São Paolo, Brazil; Belgium; Indonesia; Shanghai, China; Kinshasa, DRC; Cape Town, South Africa; and Blantyre, Malawi. Results from the longitudinal GEAS will help to answer important questions about the formation and manifestations of gender inequality, its relationship to health and well-being and the interventions that are effective in promoting gender equality.

Current activities include efforts to improve awareness of and response to ethical issues in research and programming with adolescents living in vulnerable contexts the development of a special supplement using baseline GEAS focused on gender equality. At present, students are involved in manuscript development with partners in China, Ecuador, Bolivia and Malawi. For more information about the GEAS, including our global network of collaborators, recent reports and publications and open-access survey and training instruments, please visit the GEAS website.

Grads2Careers Process Evaluation

Kristin Mmari
In an effort to reduce the number of opportunity youth, Baltimore’s Promise Career Pathways Demonstration Model (Grads2Careers) is a new program that aims to connect recent high school graduates to careers by providing career readiness training, occupational training, and wraparound supports. To understand how Grads2Careers is implemented across various occupational training sites, we are conducting a process evaluation to measure feasibility, acceptability, fidelity, systems change and institutional alignment, as well as overall sustainability and scalability. Process data will provide a rich understanding of the extent to which Grads2Careers is able to develop a clear pathway from high school to employment among opportunity youth, including barriers and facilitators, and its overall contribution to reducing opportunity youth in Baltimore City.

Harriet Lane Clinic’s Title X Program

Arik V. Marcell
Funded by the Baltimore City Health Department to provide reproductive health services to adolescents & young adults who are uninsured, underinsured or seeking confidential services and conduct quality improvement strategies to ensure providers are delivering quality family planning and sexual and reproductive health care services.

Improving the Detection of STIs in the Pediatric Emergency Department: A Pragmatic Trial

Maria Trent
Sexually transmitted infections (STIs) are highly prevalent among adolescents. Despite established principles for STI control, clinical practices related to screening and diagnosis, treatment, and prevention of STIs among adolescents are suboptimal. There is an urgent need to expand our screening programs to nontraditional healthcare settings such as emergency departments (ED) to reach those adolescents who would otherwise not receive preventive healthcare, and to determine the most efficient and cost-effective method for providing this screening. The goal of this application is to leverage our recent insights obtained from single center ED-based adolescent gonorrhea and chlamydia screening research and apply them across a national pediatric ED research network to determine the most clinically effective and cost-effective screening approach for adolescents when implemented into a real-world clinical setting through a pragmatic trial. This will be accomplished through a network of children’s hospital EDs with a track record of robust research collaboration (Pediatric Emergency Care Applied Research Network or PECARN). This research will contribute to the evidence base for creating clinically effective, cost-effective, and sustainable GC/CT screening programs that can be successfully implemented into the clinical workflow of the ED. It will also improve diagnosis of asymptomatic STIs and decrease the time interval to treatment, consequently decreasing reinfection rates of transmission and the overall STI burden as well as decreasing healthcare costs. This intervention will rely on an innovative approach that electronically integrates patient-reported data to guide clinical decision support. This work is significant because it has the potential to shift current ED clinical practice paradigms from only acute health encounters to participation in the broader management of public health, and it will fill gaps in the literature needed to provide evidence for the best method of gonorrhea and chlamydia screening in an ED setting. First, we will apply human factors modeling methods to perform ED workflow evaluations at each participating pediatric ED to determine the most efficient way to integrate the screening process into everyday clinical care. Following these analyses, we will conduct a comparative effectiveness pragmatic trial of targeted STI screening (screening only those disclosing high risk sexual behavior) versus universally-offered STI screening (offered to all, regardless of risk) through electronic integration of patient reported data for provision of clinical decision support. We will then develop decision analytic models to evaluate the cost-effectiveness of targeted screening compared to universally offered screening. This research is novel in that it shifts the usual clinical practice paradigm in the ED from STI diagnosis in symptomatic adolescents to STI screening and prevention, an approach that is critical to addressing the STI epidemic among adolescents.

Medical Consultation for Baltimore City School Based Health Program

Maria Trent
This a service contract for medical oversight for clinical services provided to adolescents by physicians and advanced nurse practitioner staff in school health clinics.

Meaningful Use of Technology to Improve Health Care Delivery (DepoText Project)

Maria Trent
Randomized pilot trial designed to determine the feasibility and acceptability of an SMS program to assist adolescents and young adults who have selected Moderately-long Acting Reversible Contraceptives (MARCS) with clinic attendance at family planning appointments. To learn more, visit the Meaningful Use of Technology to Improve Health Care Delivery page.

Prevention in Churches

Terrinieka Powell
To better understand the influence, if any, of churches on HIV risk and protective behaviors among young adult (ages 18-25) Black men who have sex with men (BMSM) by 1) exploring the relationship between HIV risk and protective behaviors (e.g., HIV testing, condom and substance use) and experiences in churches among BMSM and 2) assessing the extent to which churches can increase HIV voluntary counseling and testing (VCT), risk reduction, and health promotion among BMSM. (Complete)

Project Connect Baltimore

Arik V. Marcell
CDC-funded program to evaluate school and community-based methods to engage males in HIV/STD testing and sexual and reproductive health care in Baltimore City by training youth-serving professionals on a web-based clinical services provider guide for male-specific clinical services ( Current work includes sustainability of that has been expanded into a comprehensive youth resource for Baltimore City.

Quality improvement to integrate HIV testing in the Harriet Lane Clinic’s Title X Program

Arik V. Marcell
Funded by the Office of Population Affairs, the goal of this program is to integrate rapid HIV testing as part of Title X services and increase the proportion of clients receiving HIV test results and evaluate increased use using rapid Plan-Do-Study-Act cycles.

Technology Enchanced Community Health Nursing to Reduce Recurrent STIs after PID

Maria Trent
This study examines the efficacy of a technology-enhanced community health nursing intervention on adherence to PID treatment recommendations and subsequent short-term sexually transmitted infection acquisition using a randomized controlled trial.


Arik V. Marcell
Funded by the NIHCD, this study evaluates the feasibility, acceptability, and preliminary efficacy of Text4Father among first-time lower income fathers. Text4Father is a text messaging educational program delivered from mid-pregnancy through 2 months of postnatal age.