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Objective: To compare self-reported safe sleep data from a community social service agency and primary care centers., Design, Settings, and Participants: Cross-sectional Pregnancy Risk Assessment Monitoring System (PRAMS)-based survey data from a community social service agency and survey data from primary care centers were compared using descriptive statistics. There were 166 community survey respondents, average age of 25 years (SD = 5.4 years), and 79 primary care center respondents, average age of 24 years (SD = 5.4 years). Two binary logistic regressions were performed to examine the association between demographic differences and safe sleep position/bed sharing., Results: Safe sleep position responses did not differ significantly between the community-based (n = 126, 85%) and primary care center-based (n = 62, 79%) samples, χ(2)(1) = 0.79, P = .372. Reported bed sharing was significantly higher in the community sample (n = 54, 36%) than the health care center sample (n = 4, 5%), Fisher's exact test, P< .001. Black race was determined to be significantly associated with increased unsafe sleep positioning (OR = 2.86, P = .022). The community center cohort was the only significant predictor of bed sharing (OR = 25.40, P = .002)., Conclusion: Differences in reported safe sleep environments may be due to knowledge variances of safe sleep guidelines, or clinic-based respondents may have been more likely to provide socially desirable responses. The comparison data further highlight the need for continued targeted effort to improve safe sleep behaviors to improve infant health outcomes., (© The Author(s) 2015.)

Low health literacy is associated with poor health outcomes. Research is needed to understand the mechanisms and pathways of its effects. Computer-based assessment tools may improve efficiency and cost-effectiveness of health literacy research. The objective of this preliminary study was to assess if administration of the Short Test of Functional Health Literacy in Adults (STOFHLA) through a computer-based medium was comparable to the paper-based test in terms of accuracy and time to completion. A randomized, crossover design was used to compare computer versus paper format of the STOFHLA at a Midwestern family medicine residency program. Eighty participants were initially randomized to either computer (n = 42) or paper (n = 38) format of the STOFHLA. After a 30-day washout period, participants returned to complete the other version of the STOFHLA. Data analysis revealed no significant difference between paper- and computer-based surveys (p = .9401; N = 57). The majority of participants showed "adequate" health literacy via paper- and computer-based surveys (100% and 97% of participants, respectively). Electronic administration of STOFHLA results were equivalent to the paper administration results for evaluation of adult health literacy. Future investigations should focus on expanded populations in multiple health care settings and validation of other health literacy screening tools in a clinical setting.

Purpose: Breastfeeding is a potential solution to improve health outcomes for adolescent mothers and infants. Adolescence is a risk factor for low breastfeeding rates and is associated with a higher risk for perinatal complication. This study investigated facilitators and barriers to adolescent breastfeeding initiation and duration in an urban setting., Methods: Four, 1-hour focus groups were conducted. Twenty-nine (N = 29) adolescent mothers and pregnant adolescents participated and described attitudes toward breastfeeding, attitudes among family and friends, current knowledge, and barriers and facilitators for breastfeeding., Results: Four themes emerged, including the following: behavioral histories of breastfeeding, community assets, social support, and barriers. Participants identified positive histories and community resources such as local hospitals and social services as facilitators. Lifestyle, independence, lack of support from family and primary care providers, social stigma/embarrassment, and difficulty with breastfeeding techniques were described as barriers., Conclusion: A comprehensive and integrated primary care and public health community effort is needed to support and improve adolescent breastfeeding. Further examination of integrated interventions focused on adolescent breastfeeding behaviors through an environmental approach is needed.