Unequal Spatial Consequences of Abortion Restrictions in Texas, 2021-2023.

Objectives. To demonstrate the spatially uneven effects of abortion restriction laws in Texas. Methods. We used network analysis to determine the change in distance to the nearest surgical abortion provider for 5253 Texas neighborhoods after the passing of Texas Senate Bill 8 (SB8; 2021) and the US Supreme Court's Dobbs v Jackson Women's Health Organization (2022) decision. We identified associations between key measures of neighborhood socioeconomic context and change in distance to providers using multivariable linear regression models. Results. After the Dobbs decision, Texas residents experienced an average change in distance to the nearest provider of 457 miles (SD = 179). Neighborhoods of concentrated disadvantage experienced the greatest increase in distance to abortion providers after SB8's passing, and neighborhoods with high levels of income inequality experienced the greatest increase in distance after the Dobbs decision. Conclusions. We document the rapidly changing abortion landscape in a highly restrictive state and show that women living in more disadvantaged and unequal areas are most affected by the increasing distance to providers. Public Health Implications. Our methods and findings will continue to be relevant in understanding the burden placed on women in areas where medical abortion has been restricted because of the Dobbs decision. (Am J Public Health. Published online ahead of print May 23, 2024:e1-e10. https://doi.org/10.2105/AJPH.2024.307652).

Loneliness and friendlessness among adolescents in 25 countries in Latin America and the Caribbean.

BACKGROUND: Loneliness is a common health problem among the elderly but is not well understood in the adolescent population, especially in low- and middle-income countries (LMICs). Adolescent loneliness can have adverse impacts on short- and long-term health status. METHODS: This study examined rates of self-reported loneliness and friendlessness among 76,982 secondary school students in 25 LMICs in Latin America and the Caribbean who participated in the Global School-based Student Health Survey (GSHS). After calculating the rates of reported loneliness and lack of close friends separately for nationally representative samples of boys and girls from each country, we used meta-analysis to pool results for prevalence rates and associations across all 25 countries and territories. RESULTS: About 1 in 6 students (18.1% [95% CI: 16.4%, 20.0%]) reported being lonely most or all of the time and/or having no close friends, including 19.9% of girls and 16.2% of boys. Girls were more likely than boys to report being lonely most or all of the time (14.6% vs. 9.2%, p < .05), but boys were more likely than girls to report that they had zero close friends (8.7% vs. 7.2%, p < .05). However, the majority of students who reported being lonely did not report having no close friends, and the majority of students who reported having no close friends did not report being lonely most or all of the time. CONCLUSIONS: Asking adolescents about both loneliness and friendships may capture the burden of social isolation among males and females better than a single question about loneliness. Successful interventions for reducing social isolation must be rooted in communities and integrated into comprehensive school and community health plans.

Sexual Networks and STI Infection Among Young Black Men Who Have Sex With Women in a Southern U.S. City.

PURPOSE: The configuration of one's sexual network has been shown to influence sexually transmitted infection (STI) acquisition in some populations. Young Black men who have sex with women (MSW) have high rates of STIs, yet little is known about their sexual networks. The purpose of this study is to describe the characteristics of sexual networks and their association with selected STI infections among young Black MSW. METHODS: Black MSW aged 15-26 years who were enrolled in the New Orleans community-based screening program named Check It from March 2018 to March 2020 were tested for C. trachomatis and N. gonorrhoeae infection and asked about the nature of their sexual partnerships. Sexual partnerships with women were defined as dyadic, somewhat dense (either themselves or their partner had multiple partners), and dense (both they and their partner(s) had multiple partners). RESULTS: Men (n = 1,350) reported 2,291 sex partners. The percentage of men who reported their networks were dyadic, somewhat dense, and dense was 48.7%, 27.7%, and 23.3%, respectively; 11.2% were STI-positive and 39.2% thought their partner(s) had other partners. Compared to men in dyadic relationships, those in somewhat dense network did not have increased risk of STI infection, but those in dense networks were more likely to have an STI (adjusted odds ratio = 2.06, 95% confidence interval [1.35-3.13]). DISCUSSION: Young Black MSW, who had multiple partners and who thought their partner(s) had other sex partners were at highest risk for STIs. Providers should probe not only about the youth's personal risk but should probe about perceived sexual partners' risk for more targeted counseling/STI testing.

Trends in contraceptive method mix among adolescents and youth aged 15-24 in low- and middle-income countries.

Background: Method mix - the percent distribution of contraceptive use by method among contraceptive users - reflects both client choice of method and method availability. In a country where clients have access to a wide range of methods at an affordable price, method mix is a strong proxy for method choice. In contrast, where access is limited by numerous factors - method availability, cost, or provider attitudes - method mix may not capture method choice well. Given that method mix can be measured reliably from population-based surveys, it is useful in exploring method choice. While the method mix for all women of reproductive age (15-49 years) has been described previously, the method mix for adolescents and young women aged 15-24 remains unexplored despite this population's high risk for unintended pregnancy. Objectives: This study investigates the contraceptive method mix for women aged 15-24 in low- and middle-income countries (LMICs) with national survey data and describes how the method mix differs by age group, geographic region, and marital status for women. Methods: Using data from the Demographic and Health (DHS) Surveys, the contraceptive method mix among women aged 15-24 across 64 LMICs is analyzed by age, marital status, and region, with measures of skew and average deviation. Three case studies are presented in which the trend over time in the method mix is examined. Results: There are large variations in method mixes across regions, which reflect their differences in various supply and demand constraints. However, there is consistently high usage of short-acting methods among both age groups, 15-19 and 20-24, compared to the full population of all women of reproductive age. Male condoms overwhelmingly predominate as the method used by women 15-24 in all regions. Conclusion: The marked differences found by marital status, region, and age show the need for programs to be tailored to local circumstances. Additionally, the large unmet need for contraception signals the ongoing urgency for strengthened programmatic efforts, and for a wider offering of methods to enlarge the choices available to young women. Unmarried women in particular deserve attention, as well as young married women who wish to postpone a pregnancy.