Provider perspectives on a point-of-care tool to facilitate patient-centered contraceptive care among Latina/x patients in Baltimore, MD.

Objectives: To explore clinician perspectives on the development, utility, and feasibility of a provider-facing point-of-care tool to assist in provision of patient-centered contraceptive care for Latina/x patients in Baltimore, MD. Methods: We conducted 25 semi-structured qualitative interviews with a sample of clinicians who provide contraceptive care to Latina/x patients. An interview guide was developed based on prior research related to patient-centered care and extant point-of-care tools. Transcripts were independently coded by two study team members and analyzed using a directed content analysis approach. Results: Four themes emerged from the data: (1) clinician perception of a need for a tool to facilitate patient-centered contraceptive care, (2) concern for tool burden and burnout, (3) desire for tool ease of use, and (4) a need for cultural awareness during tool development to avoid bias and typecasting. Conclusions: A provider-facing, point-of-care tool to facilitate patient-centered contraceptive counseling was acceptable among providers, provided the tool is easy to use and promotes cultural awareness. Innovation: In the current era of more limited reproductive choice across the U.S., the need and support for non-coercive, patient-centered contraceptive care is timely. A provider-facing, point-of-care tool can facilitate the provision of patient-centered care among clinicians proving contraceptive counseling to Latina/s.

Qualitative assessment of the impacts of the COVID-19 pandemic on migration, access to healthcare, and social wellbeing among Venezuelan migrants and refugees in Colombia.

Background: Colombia hosts a large number of Venezuelan migrants and refugees who are uniquely vulnerable and have been markedly impacted by the COVID-19 pandemic. It is necessary to understand their experiences to inform future policy decisions both in Colombia and during disease outbreaks in other humanitarian contexts in the future. As part of a larger study focused on HIV among Venezuelans residing in Colombia, qualitative interviews were conducted to understand this population's experiences and access to healthcare. Methods: Interviews were conducted with Venezuelan migrants and refugees as well as stakeholders such as care providers, humanitarian workers, and government officials. Interviews were recorded, transcribed, and coded using thematic content analysis. Select quotes were translated and edited for length and/or clarity. Results: Venezuelan migrants and refugees reported high levels of housing instability, job instability, increased barriers to accessing healthcare, and complications in engaging in the HIV care continuum, among other impacts of the COVID-19 pandemic. Stakeholders reported complications in provision of care and obtaining medicines, difficulty maintaining contact with patients, increased discrimination and xenophobia targeting Venezuelan migrants and refugees, increased housing instability among Venezuelan migrants and refugees, and other impacts as a result of the COVID-19 pandemic. Conclusions: This study demonstrates the unique impacts of the COVID-19 pandemic among Venezuelans residing in Colombia by both compounding extant vulnerabilities and introducing new challenges, such as high rates of eviction. Colombia has enacted increasingly inclusive migration policies for Venezuelan refugees and migrants within the country; findings from this study underscore the necessity for such policies both in and outside of the Colombian context.

Provider perspectives on patient-centered contraceptive counseling for Latinas in Baltimore, MD.

OBJECTIVES: To explore: 1) provider narratives of their contraceptive counseling practices with Latina patients within the context of patient-centered care (PCC); and 2) provider perceptions about the barriers to the provision of patient-centered contraceptive counseling in general and more specifically, with Latina patients in Baltimore, MD. STUDY DESIGN: We conducted 25 semistructured qualitative interviews with physicians  and nurse practitioners from four specialties who provide contraceptive care to Latinas in Baltimore, MD. We analyzed data using directed content analysis. We discuss findings with attention to major constructs of PCC, applying a reproductive justice framework. RESULTS: Providers described a contraceptive counseling approach focused on pregnancy prevention as the primary goal. Most respondents used a tiered-effectiveness approach, even while noting the importance of PCC. Providers noted health system barriers to PCC, including time constraints and insurance status. Provider-reported patient-attributed barriers included low patient education/health literacy, culturally-attributed misconceptions about contraception, and language discordance. CONCLUSION: Providers described knowledge of and intention to practice PCC but had limited integration of it in their own counseling with Latinas. Responses suggest tension between an expressed desire to provide PCC and paternalistic counseling paradigms that prioritize pregnancy prevention over patient preferences. Inequitable health system barriers also interfere with true implementation of contraceptive PCC. IMPLICATIONS: Translating contraceptive PCC into practice, especially for marginalized communities, is paramount. Training should teach clinicians to recognize systems of structural inequity and discrimination that have informed approaches to counseling but are not reflective of PCC. Institutional policies must address health system barriers that also hamper PCC.

Sexual harassment before and during the COVID-19 pandemic among adolescent girls and young women (AGYW) in Nairobi, Kenya: a cross-sectional study.

OBJECTIVES: Sexual harassment among adolescent girls and young women (AGYW) is a prevalent and understudied form of gender-based violence (GBV) with negative impacts on health and well-being. The COVID-19 pandemic raised global concern about GBV within homes; less is known about how it affected GBV in public spaces. METHODS: Present analyses use cross-sectional data from a cohort of adolescents and young adults residing in Nairobi, Kenya, restricted to female participants. Data were collected August-October 2020 via phone after implementation of COVID-19 restrictions. Prevalence of past-year sexual harassment and harassment relative to COVID-19 restrictions were calculated for overall sample, and by individual, household, and pandemic-related factors. Multivariate negative binomial regression models examine correlates of (1) past-year sexual harassment and (2) increases in sexual harassment relative to COVID-19 restrictions. RESULTS: Overall, 18.1% of AGYW experienced past-year sexual harassment at the 2020 survey. Among this group, 14.6% experienced sexual harassment pre-COVID-19 only, 18.8% after only and 66.6% at both time points. Among the latter group, 34.9% reported more occurrences following COVID-19 restrictions, 20.5% reported less occurrences and 44.7% reported no change in occurrence. Overall, 42.0% of AGYW experienced an increase in sexual harassment while 58.0% experienced no increase since COVID-19. In adjusted models, past-year sexual harassment was associated with higher educational attainment (adjusted risk ratio, aRR 2.11; 95% CI 1.27 to 3.52) and inability to meet basic financial needs (aRR 1.67; 95% CI 1.05 to 2.66). Increased sexual harassment since COVID-19 was associated with having full control to leave the home (aRR 1.69; 95% CI 1.00 to 2.90). CONCLUSIONS: Sexual harassment among AGYW in Nairobi, Kenya was prevalent before and during COVID-19 restrictions. Safety in public spaces remains a highly gendered issue that impacts women's safety and ability to participate in public life. Prevention and support services to address sexual harassment remain an important element in ensuring safe, sustainable public spaces.

"We are Getting Those Old People Things." Polypharmacy Management and Medication Adherence Among Adult HIV Patients with Multiple Comorbidities: A Qualitative Study.

Introduction: Improvements in treatment have led to a growing population of older adults living with HIV. As this population ages, polypharmacy, or the use of more than five medications, may become more common among people living with HIV (PLWH). Methods: Two qualitative focus groups (N=7, N=8) were conducted among a sample of patients who participated in a larger study regarding differential medication adherence. Open-ended questions and probes focused on barriers and facilitators to multiple medication management as well as differential adherence. Results: Overall, patients were able to manage their polypharmacy. Social support facilitated adherence while long-term antiretroviral (ARV) use, medication-specific requirements and emotional fatigue were barriers to management. A small number of participants reported differential adherence that prioritized non-HIV medications over ARVs due to more immediate effects of non-adherence. Discussion: Findings suggest that PLWH have learned to manage their polypharmacy, but still face significant challenges adhering to multiple medications in the long-term. Future research may focus on the emotional toll of long-term ARV use and how patients' own management strategies may be leveraged to promote adherence.

Assessing the Feasibility and Effectiveness of a Linkage Into Mental Health Care Program for Adults Affected by Hurricane Sandy.

OBJECTIVE: Research indicates that greater exposure to Hurricane Sandy is associated with increased mental health difficulties. This study examined whether Project Restoration, a program that linked adults into mental health care (L2C), was effective in reducing post-Sandy mental health difficulties as compared to a cohort of adults matched on mental health difficulties that were not linked into post-Sandy mental health care. METHODS: Project Restoration participants (n = 52) with elevated self-reported mental health difficulties had the option to enroll into L2C. Project LIGHT (n = 63) used similar methodologies but did not have a L2C component and served as the matched control group. RESULTS: Multivariable modeling showed significant decreases in all mental health difficulties except for depression in the Project Restoration group, whereas there were no significant decreases in LIGHT. The decrease in anxiety from baseline to follow-up was significantly greater for Project Restoration as compared to LIGHT. CONCLUSION: Findings confirm the powerful impact community outreach and treatment have on reducing mental health difficulties after a disaster.

Cervical cancer knowledge and barriers and facilitators to screening among women in two rural communities in Guatemala: a qualitative study.

BACKGROUND: Approximately 80% of deaths due to cervical cancer occur in low- and middle-income countries. In Guatemala, limited access to effective screening and treatment has resulted in alarmingly high cervical cancer incidence and mortality rates. Despite access to free-of-cost screening, women continue to face significant barriers in obtaining screening for cervical cancer. METHODS: In-depth interviews (N = 21) were conducted among women in two rural communities in Guatemala. Interviews followed a semi-structured guide to explore knowledge related to cervical cancer and barriers and facilitators to cervical cancer screening. RESULTS: Cervical cancer knowledge was variable across sites and across women. Women reported barriers to screening including ancillary costs, control by male partners, poor provider communication and systems-level resource constraints. Facilitators to screening included a desire to know one's own health status, conversations with other women, including community health workers, and extra-governmental health campaigns. CONCLUSIONS: Findings speak to the many challenges women face in obtaining screening for cervical cancer in their communities as well as existing facilitators. Future interventions must focus on improving cervical cancer-related knowledge as well as mitigating barriers and leveraging facilitators to promote screening.

Safe and Stable Housing for Intimate Partner Violence Survivors, Maryland, 2019‒2020.

House of Ruth Maryland is a comprehensive intimate partner violence (IPV) service provider. Our academic‒practitioner partnership conducted a prospective, quasi-experimental evaluation (n = 70) of on-site transitional housing and community-based rapid rehousing to meet the safety and stability needs of individuals made homeless because of IPV. By 6-month follow-up, both IPV revictimization and housing instability significantly improved (P < .001). Housing supports through an IPV service provider advanced the dual goals of safety and housing stability for IPV survivors. Safe, affordable housing is an IPV prevention strategy. (Am J Public Health. 2022;112(6):865-870. https://doi.org/10.2105/AJPH.2022.306728).

A Retrospective Descriptive Analysis of Sexual Assault Nurse Examiner Records From Sexual Assault Survivors at a Large University Emergency Department From 2003 to 2017.

This retrospective descriptive analysis of 837 patients seeking postassault care at an academic hospital in the United States describes characteristics of sexual assault survivors from a sociocultural context, with a specific focus on describing survivors presenting for sexual assault nurse examiner (SANE) exams and confirming existing literature on assault characteristics, such as disabilities and alcohol and/or drug use. Assaults resulting in SANE exams increased over time. Drug and/or alcohol use at the time of the assault was reported in 44.8% of cases and 20.8% of survivors reported having a disability. Understanding the demographic and sexual assault characteristics of survivors is fundamental to providing sensitive and responsive care.

Educational Attainment and Quality of Life among Older Adults before a Lung Cancer Diagnosis.

Background: Demographic and contextual factors are associated with quality of life (QoL) in older adults and prediagnosis QoL among older adults has important implications for supportive care in older cancer patients. Objective: To examine whether lower educational attainment is associated with poorer QoL among community dwelling older adults just before their diagnosis of lung cancer in a nationally representative sample. Design: This study used the Surveillance, Epidemiology, and End Results (SEER)-Medicare Health Outcomes Survey (MHOS) dataset, which provides cancer registry data linked with survey data for Medicare Advantage enrollees. Subjects: Adults 65 years and older at time of diagnosis with first or only primary lung cancer and with at least one survey before their cancer diagnosis. Measurements: Level of education attained was categorized as less than high school (

Change in Quality of Life after a Cancer Diagnosis among a Nationally Representative Cohort of Older Adults in the US.

Age-related decreases in Quality of Life (QoL) are often compounded by comorbidities, including cancer. This study aimed to examine QoL changes before and after a new cancer diagnosis using data from the National Health and Aging Trend Study (NHATS), linked to Medicare claims (N = 136). There was a significant increase in the relative odds of fair/poor self-reported health and needing help with Activities of Daily Living. There was also a marginal increase in depression, but no change in anxiety or pain scores. Results underscore importance of considering pre-cancer QoL when making treatment decisions for older adult cancer patients.