Search results

Background Recognizing that quality family planning services should include services to help clients who want to become pregnant, the objective of our analysis was to examine the distribution of services related to achieving pregnancy at publicly funded family planning clinics in the United States. Methods A nationally representative sample of publicly funded clinics was surveyed in 2013–2014 (n = 1615). Clinic administrators were asked about several clinical services and screenings related to achieving pregnancy: basic infertility services, reproductive life plan assessment, screening for body mass index, screening for sexually transmitted diseases, provision of natural family planning services, infertility treatment, and primary care services. The percentage of clinics offering each of these services was compared by Title X funding status; prevalence ratios (PR) and 95% confidence intervals (CIs) were estimated after adjusting for clinic characteristics. Results Compared to non-Title X clinics, Title X clinics were more likely to offer reproductive life plan assessment (adjusted PR [aPR], 1.62; 95% CI, 1.42–1.84), body mass index screening for men (aPR, 1.10; 95% CI, 1.01–1.21), screening for sexually transmitted diseases (aPRs ranged from 1.21 to 1.37), and preconception health care for men (aPR, 1.10; 95% CI, 1.01–1.20). Title X clinics were less likely to offer infertility treatment (aPR, 0.55; 95% CI, 0.40–0.74) and primary care services (aPR, 0.74; 95% CI, 0.68–0.80) and were just as likely to offer basic infertility services, preconception health care services for women, natural family planning, and body mass index screening in women. Conclusions The availability of selected services related to achieving pregnancy differed by Title X status. A follow-up assessment after publication of national family planning recommendations is underway.

Obesity is a global epidemic affecting millions. Implementation of interventions to curb obesity rates requires timely surveillance. In this study, we estimated sex-specific obesity prevalence using social media, search queries, demographics and built environment variables. We collected 3,817,125 and 1,382,284 geolocated tweets on food and exercise respectively, from Twitter’s streaming API from April 2015 to March 2016. We also obtained searches related to physical activity and diet from Google Search Trends for the same time period. Next, we inferred the gender of Twitter users using machine learning methods and applied mixed-effects state-level linear regression models to estimate obesity prevalence. We observed differences in discussions of physical activity and foods, with males reporting higher intensity physical activities and lower caloric foods across 40 and 48 states, respectively. In addition, counties with the highest percentage of exercise and food tweets had lower male and female obesity prevalence. Lastly, our models separately captured overall male and female spatial trends in obesity prevalence. The average correlation between actual and estimated obesity prevalence was 0.797(95% CI, 0.796, 0.798) and 0.830 (95% CI, 0.830, 0.831) for males and females, respectively. Social media can provide timely community-level data on health information seeking and changes in behaviors, sentiments and norms. Social media data can also be combined with other data types such as, demographics, built environment variables, diet and physical activity indicators from other digital sources (e.g., mobile applications and wearables) to monitor health behaviors at different geographic scales, and to supplement delayed estimates from traditional surveillance systems.

To review blockchain lessons learned in 2018 and near-future predictions for blockchain in healthcare, Blockchain in Healthcare Today (BHTY) asked the world's blockchain in healthcare experts to share their insights. Here, our internationally-renowned BHTY peer-review board discusses their major predictions. Based on their responses, presented in detail below, ten major themes (Table ) for the future of blockchain in healthcare will emerge over the 12 months.

Sexual and gender minority (SGM) youth are more likely to use alcohol than their heterosexual cisgender peers. At the same time, SGM youth experience sexuality- and gender identity-specific stressors known to exacerbate negative health outcomes. Though scholars have established a link between minority stressors (e.g., internalized stigma and victimization) and increased alcohol use for SGM youth as a whole, there is little indication of whether internalized stigma and victimization are more strongly associated with alcohol use for specific groups of SGM youth. A United States sample of 11,811 racially and geographically diverse 13–17 year old SGM youth was used to employ a series of gender-stratified multivariable regression models to examine the association among internalized stigma, victimization, and alcohol-related behaviors, and whether they differed for specific groups of sexual minority youth. Sexual orientation moderated several associations between sexual minority stressors (i.e., victimization and stigma) and youth’s alcohol use (i.e., recent use and heavy episodic drinking) across models stratified by gender (i.e., male, female, and non-binary). For example, bisexual boys had stronger associations between SGM-specific victimization and alcohol use frequency and heavy episodic drinking relative to gay boys; conversely, victimization and alcohol use frequency were more weakly associated among bisexual girls relative to lesbian/gay girls. Pansexual girls showed weaker associations between internalized stigma and alcohol use frequency compared to lesbian/gay girls. This paper demonstrates who among SGM youth are more likely to engage in alcohol-related behaviors as a function of differential forms of SGM-related victimization and stigma. These findings can inform substance use interventions that are tailored to youth of diverse sexual orientations and gender identities.

LGBTQ youth are at greater risk for compromised health, yet large-scale health promotion programs for LGBTQ young people have been slow to develop. LGBTQ community-based organizations—which provide LGBTQ-focused support and services—have existed for decades, but have not been a focus of the LGBTQ youth health literature. The current study used a contemporary sample of LGBTQ youth (age 15–21;  M  = 18.81;  n  = 1045) to examine who participates in LGBTQ community-based organizations, and the association between participation and self-reported mental health and substance use. Youth who participated in LGBTQ community-based organizations were more likely to be assigned male at birth, transgender, youth of color, and accessing free-or-reduced lunch. Participation was associated with concurrent and longitudinal reports of mental health and substance use. LGBTQ community-based organizations may be an underutilized resource for promoting LGBTQ youth health.

Objectives To assess risk and protective factors associated with bacterial vaginosis (BV) chronicity ascertained by Nugent score criteria. Methods A longitudinal cohort study included 255 sexually experienced, postmenarcheal women who provided weekly self-collected vaginal swabs for up to 2 years. Vaginal swabs were scored using Nugent criteria and classified as normal (≤3), intermediate (4–6) and Nugent-BV (≥7). Detailed behavioural/health information were assessed every 6 months. A per-woman longitudinal summary measure of BV chronicity was defined as the percentage of each woman’s weekly vaginal assessments scored as Nugent-BV over a 6-month interval. Risk and protective factors associated with BV chronicity were assessed using multiple linear regression with generalised estimating equations. Results Average BV chronicity was 39% across all follow-up periods. After adjustment, factors associated with BV chronicity included baseline Nugent-BV (β=35.3, 95% CI 28.6 to 42.0) compared with normal baseline Nugent scores and use of unprotected water for bathing (ie, rainwater, pond, lake/stream) (β=12.0, 95% CI 3.4 to 20.5) compared with protected water sources (ie, well, tap, borehole). Women had fewer BV occurrences if they were currently pregnant (β=−6.6, 95% CI −12.1 to 1.1), reported consistent condom use (β=−7.7, 95% CI −14.2 to 1.3) or their partner was circumcised (β=−5.8, 95% CI −11.3 to 0.3). Conclusions Factors associated with higher and lower values of BV chronicity were multifactorial. Notably, higher values of BV chronicity were associated with potentially contaminated bathing water. Future studies should examine the role of waterborne microbial agents in the pathogenesis of BV.

Lack of access to a health-promoting food environment can lead to poor health outcomes including obesity which is a problem for African-Americans in Prince George’s County, Maryland. Previous research examined the quality of the food environment at the regional level but did not consider local level indicators. In this study, we utilized an environmental justice framework to examine the local food environment in the County. We collected data from 127 food outlets, (convenience stores, grocery stores, and supermarkets), in three racially and socioeconomically diverse communities – Bladensburg (predominantly African American/ Black, with the lowest median household income); Greenbelt (similar percentage of non-white persons as Hyattsville, with the highest median household income); and Hyattsville (dominated by a Hispanic population). We examined the availability, quality, and accessibility of food within each community, using a modified version of the Johns Hopkins Center for a Livable Future (CLF) healthy food availability index (HFAI).We also used ArcMap 10.6 to examine the spatial distribution of stores in relation to sociodemographic factors and generate descriptive statistics to examine HFAI score differences across the communities, sociodemographic composition, and store types at the block group level. Mean HFAI scores were 7.76, 10.75, and 9.60 for Bladensburg, Greenbelt, and Hyattsville, respectively suggesting a relative disparity in access to diverse healthy and good quality food sources for these communities although these differences were not statistically significant (p=0.79). Statistically significant differences between the communities were found with respect to ethnic stores, stores that sold fresh vegetables (p=0.047), and stores that sold fresh fruits (p=0.012). Getis-Ord Gi Hot Spot Analysis revealed one statistically significant cold spot at 95% confidence, and two others at 90% confidence in Hyattsville, indicating a cluster of low-scoring stores. The results indicate a potential need for expanded food infrastructure in these communities to improve public health. We also identified the need for culturally appropriate foods and proposed ethnic stores as potential salutogens to improve the food environment in culturally diverse neighborhoods.

We examined the prospective role of parental support and adult identity profiles in the transition to adulthood on teen mothers’ socioeconomic outcomes in adulthood. Analyses were based on the National Longitudinal Study of Adolescent to Adult Health, a nationally representative sample of youth followed over a decade. We used data from Waves 1, 3, and 4 (mean age = 28.6, Wave 4). Analytical sample consisted of 981 females who gave birth before age 20. Analysis included design-based regression models. Findings from adjusted regression models showed no statistically significant associations between teen mothers’ parental support and socioeconomic outcomes. While teen mothers have already achieved an important marker of adulthood, variability in adult identity profiles was observed. Teen mothers with older subjective age, regardless of their levels of psychosocial maturation, had higher socioeconomic attainment on some indicators. Findings suggest that teen mothers’ adult identity profiles differentiate their socioeconomic trajectories later in life.

Objectives:  We examined changes in  health care access  and utilization associated with the Patient Protection and  Affordable Care Act  (ACA) for different Asian American subgroups relative to non-Latino whites (whites). Research Design:  Using 2003–2017 California Health Interview Survey data, we examined changes in 4  health care access  measures and 2 utilization measures among whites and 7 Asian American subgroups. We estimated the unadjusted and adjusted percentage point changes on the absolute scale from the pre-ACA to post-ACA periods. Adjusted estimates were obtained from multivariable logistic regression models that controlled for predisposing, enabling, and need factors. We also estimated the pre-ACA to post-ACA changes between whites and Asian American subgroups using a difference-in-difference approach. Results:  After the ACA was implemented, uninsurance decreased among all Asian American subgroups, but improvements in disparities relative to whites in these measures were limited. In particular, Koreans had the largest absolute reduction in uninsurance (−16.8 percentage points) and were the only subgroup with a significant reduction in terms of disparities relative to whites (−10.1 percentage points). However, little or no improvement was observed in the other 3 access measures (having a usual source of care, delayed medical care in past year, or delayed prescription drug use in past year) and 2 utilization measures (having a physician visit or emergency department visit in past year). Conclusions:  Despite coverage gains among Asian American subgroups, especially Koreans, disparities in access and utilization persisted across all Asian American subgroups.