Social Determinants of Health and Body Mass Index in American Indian/Alaska Native Children.

Objective: To examine the associations between social determinants of health (SDOH) and prevalent overweight/obesity status and change in adiposity status among American Indian and Alaska Native (AI/AN) children. Methods: The study sample includes 23,950 AI/AN children 2-11 years of age, who used Indian Health Service (IHS) from 2010 to 2014. Multivariate generalized linear mixed models were used to examine the following: (1) cross-sectional associations between SDOH and prevalent overweight/obesity status and (2) longitudinal associations between SDOH and change in adiposity status over time. Results: Approximately 49% of children had prevalent overweight/obesity status; 18% had overweight status and 31% had obesity status. Prevalent severe obesity status was 20% in 6-11-year olds. In adjusted cross-sectional models, children living in counties with higher levels of poverty had 28% higher odds of prevalent overweight/obesity status. In adjusted longitudinal models, children 2-5 years old living in counties with more children eligible for free or reduced-priced lunch had 15% lower odds for transitioning from normal-weight status to overweight/obesity status. Conclusions: This work contributes to accumulating knowledge that economic instability, especially poverty, appears to play a large role in overweight/obesity status in AI/AN children. Research, clinical practice, and policy decisions should aim to address and eliminate economic instability in childhood.

Overnight pain and opioid use after osmotic cervical dilator placement for second trimester dilation and evacuation.

OBJECTIVE: The aim of the study was to evaluate pain following overnight osmotic cervical dilator placement for second trimester dilation and evacuation (D&E). METHODS: A retrospective cohort study surveyed pain and quantified prescription opioid use among 100 women who underwent overnight osmotic cervical dilator placement for D&E. Participants were given opioid and non-steroidal anti-inflammatory (NSAID) prescriptions and were asked to rate their level of pain on a Likert scale (1-10). Demographic and medical information was abstracted from electronic medical records. Bivariate analyses of demographic and clinical characteristics by pain score and opioid use were conducted. Multivariate linear regression analyses were performed for pain score. A multivariate logistic regression model was fitted for factors associated with opioid use. RESULTS: Gestational age ranged from 14 to 23 weeks (average 19 ± 3 weeks). The mean score of worst pain experienced was 5.3 out of 10. Participants reported 3.4 h of moderate pain (4-6 out of 10) and 1.0 h of severe pain (7-10 out of 10); 54% of women took at least one opioid (mean 2.8 ± 1.5). Multivariate analysis showed that higher pain was associated with younger age (p = .0363) and no prior vaginal delivery (p = .0296). The number of osmotic cervical dilators was associated with pain in the bivariate analysis (r = 0.216, p = .0311) but was not significant in the multivariate analysis (p = .0634). An increasing number of cervical dilators (p = .0323) and a higher pain score (p = .004) were associated with opioid use. CONCLUSION: Most participants with overnight cervical dilators for D&E experienced at least moderate pain and used opioid pain medication in addition to NSAIDs when available. A shared decision-making model may be appropriate for determining which patients may benefit from opioids.

Client satisfaction and experience of telemedicine and home use of mifepristone and misoprostol for abortion up to 10 weeks' gestation at British Pregnancy Advisory Service: A cross-sectional evaluation.

OBJECTIVE: Evaluate satisfaction and experience with telemedicine consultation and home use of mifepristone and misoprostol for abortion to 10 weeks' gestation. STUDY DESIGN: Cross-sectional evaluation of British Pregnancy Advisory Service (BPAS) clients who used mifepristone and misoprostol at home from 11 May to 10 July 2020. We sent a text message with a link to a web-survey 2 to 3 weeks postabortion. Questions assessed satisfaction and experiences with a service model including telephone consultation and provision of medicines by mail or collection from the clinic. We used bivariate and multivariate regression to explore associations between client characteristics and outcomes. Our primary outcomes were overall satisfaction (5-point Likert scale) and reported contact with a health care provider. RESULTS: A total of 1,333 clients participated. Respondents described home use of medications as "straightforward" (75.8%) and most were "very satisfied" (78.3%) or "satisfied" (18.6%) overall. Being "very satisfied" was associated with parity (aOR 1.53, 95% CI 1.09-2.14) and pain control satisfaction (aOR 2.22, 95% CI 1.44-3.44). Health care provider contact was reported by 14.7%; mainly to BPAS' telephone aftercare service (76.8%). Dissatisfaction with pain control (aOR 3.62, 95% CI 1.79-7.29) and waiting >1 week to use mifepristone (aOR3.71, 95% CI 1.48-9.28) were associated with health care provider contact. If needed in the future, most would prefer consultation by phone (74.3%) and home use of mifepristone and misoprostol (77.8%). CONCLUSIONS: Satisfaction with telemedicine and home use of mifepristone and misoprostol is high. Most clients do not need health care provider support when administering medicines at home or post abortion.

Stigma surrounding contraceptive use and abortion among secondary school teachers: A cross-sectional study in Western Kenya.

OBJECTIVES: Comprehensive sexual education plays an essential role in adolescent sexual and reproductive health and rights (SRHR). The study aim was to investigate Kenyan secondary school teachers' attitudes toward girls associated with contraceptive use and abortion. STUDY DESIGN: We conducted a cross-sectional study in January 2018 among school teachers (n = 144) at 4 religiously affiliated suburban secondary schools in Kenya and used 2 validated Likert Scales (1-5) to capture contraception and abortion stigma. RESULTS: Overall, 122 teachers responded (85%) (females, 57%; males 43%; age, 21-70 years [mean, 36]). Respondents associated contraceptive use with a promiscuous lifestyle (43%) that will encourage peers to do the same (51%). Respondents indicated that married women were more deserving of contraception than unmarried women (57%), a girl could not herself decide to use contraceptives (50%), and contraceptive use could impair future fertility (57%). Abortion was considered a sin (74%), shameful for the family (48%), a habit (34%), and a behavior that might encourage peers to do the same (51%). Many believed an abortion will lead to worse health (73%). Male and female teachers gave similarly distributed responses. Younger teachers were more likely to find abortion shameful (<29, 64%; 30-39, 39%; ≥40, 39%; p = 0.046). Contraception stigma and abortion stigma were highly correlated (r = 0.355, p < 0.001). CONCLUSIONS: Stigmatizing attitudes associated with contraceptive use and/or abortion were common among teachers in Western Kenya. IMPLICATIONS: Stigma may hinder the sexual and reproductive health and rights of students. Contraceptive use and abortion stigma need to be addressed in teacher education to ultimately improve health outcomes among adolescents.

Contraception Choice Among Those Seeking Abortion for Fetal Indication or Management of Pregnancy Loss.

OBJECTIVE: To compare contraception choices of those who are undergoing abortion procedures for fetal indications or surgical management of pregnancy loss with those who are having abortions for another indication. METHODS: We conducted a cross-sectional study at University of California, Irvine, from December 1, 2017, through December 31, 2018, and included gestational ages up to 24 0/7 weeks. We abstracted data from electronic medical records and analyzed them using descriptive statistics, χ2, Fisher exact tests, and a multivariate logistic regression model for primary outcome (whether a contraception method was chosen) and secondary outcome (whether a long-active reversible contraception was chosen). RESULTS: Those with fetal indication were less likely to choose contraception than those with other indication (68/134, 50.7% vs 142/158, 89.9%, P<.001), and among those choosing contraception those with fetal indication were less likely to choose long-acting reversible contraception (LARC) (19/68, 27.9% vs 94/142, 66.2%, P<.001). Differences remained significant in multivariable analysis that controlled for age, gestational age in weeks, race, parity, procedure type, and comorbidities (among those with fetal indication for choosing any contraception: adjusted odds ratio [aOR] 0.11, 95% CI 0.05-0.23; choosing LARC: aOR 0.17, 95% CI 0.07-0.39). CONCLUSION: Only half of those seeking abortion for a fetal indication or surgical management of pregnancy loss were interested in contraception.