Vax attacks: How conspiracy theory belief undermines vaccine support.

As the world continues to respond to the spread of a novel coronavirus (SARS-CoV-2, which causes the disease commonly known as COVID-19), it has become clear that one of the most effective strategies for curbing the pandemic is the COVID-19 vaccine. However, a major challenge that health organizations face when advocating for the uptake of the COVID-19 vaccine is the spread of related misinformation and conspiracy theories. This study examines factors that influence vaccine hesitancy using two online survey samples, one convenience and one nationally representative, collected in the early summer of 2020 during the height of the second peak of coronavirus cases in the United States. Given extant literature on vaccine hesitancy and conspiracy belief, we expect that three factors-conspiracy theory belief, political identity, and anti-intellectualism-have served to reduce COVID-19 vaccination likelihood. Accordingly, across our two independent samples we find that anti-intellectualism, conspiratorial predispositions, and COVID-19 conspiracy theory belief are the strongest and most consistent predictors of COVID-19 vaccine hesitancy. Notably, we also find that partisanship and political ideology are inconsistently significant predictors of COVID-19 vaccine hesitancy once conspiracy theory beliefs, anti-intellectualism, and control variables are accounted for in the models. When political tendencies are significant, they demonstrate a relatively small substantive association with COVID-19 vaccine hesitancy. We discuss implications for ongoing mass vaccination efforts, continued widespread vaccine hesitancy, and related political attitudes.

The impacts of contraceptive stock-outs on users, providers, and facilities: A systematic literature review.

Contraceptive stock-outs are a world-wide problem, yet published research on the impacts of contraceptive stock-outs have not been comprehensively reviewed and synthesised. This systematic review highlights findings about the impacts of contraceptive stock-outs on users, providers, and facilities and identifies topics that should be explored to ensure everyone can access their preferred method of contraception. We systematically searched PubMed, Embase, Web of Science, Popline, and JSTOR for studies addressing the impacts of contraceptive stock-outs. Of 435 studies, 25 publications addressed the impacts of contraceptive stock-outs. Only two articles focused solely on contraceptive stock-outs; the remaining studies examined stock-outs alongside other factors that may influence contraceptive service provision. Studies discussed how stock-outs limited individuals' ability to use their preferred contraceptive method, influenced where contraceptive methods were obtained and how much they cost, and limited providers' and facilities' abilities to provide contraceptive care. Comparing the impacts of contraceptive stock-outs across studies was challenging, as reliability of stock was sometimes not distinguished from overall method availability, and studies used variable methods to measure stock-outs. Evidence presented in this review can inform efforts to ensure that preferred contraceptive methods are consistently available and accessible to all.

Mixed-methods investigation of women's experiences with second-trimester abortion care in the Midwest and Northeast United States.

OBJECTIVE(S): We studied women's experiences seeking and receiving second-trimester abortion care in two geographically and legislatively different settings to inform ways to improve abortion care access and services. STUDY DESIGN: We conducted in-depth interviews with women who obtained second-trimester abortion care. Themes from the interviews were then used to inform a self-administered survey, which was completed by 108 women who received second-trimester abortion care in the Northeast and Midwest. We calculated descriptive statistics and used chi-squared and t-tests to compare responses. RESULTS: We interviewed eight women and surveyed 108 women. Most interviewees and 65.2% of survey respondents reported difficulties accessing care. Although most interview and survey respondents had insurance, a slight majority reported difficulty funding care. All interviewees and 57.9% of survey respondents reported positive experiences with providers, with many interviewees and 62.0% of survey respondents saying their abortion care was better than their usual health care. Most interviewees and 75.8% of survey respondents reported pain as low to moderate, and the majority of participants reported it was the same or less than expected. Knowledge about abortion restrictions was low. Most interviewees and 68.4% survey respondents disagreed with restrictions on insurance coverage of abortion. Common recommendations to improve experiences were to ensure travel and financial support and to decrease wait times at clinics. There were few regional differences among outcomes. CONCLUSION(S): Women seeking second-trimester abortion in these locations reported positive abortion experiences. However, they had to overcome significant obstacles to obtain care. IMPLICATIONS: This is the first study to systematically research women's second-trimester care experiences in two different regions of the United States. Regardless of location, women experienced barriers due to policies that impose gestational age restrictions, limit provider availability (consequently increasing wait times), and increase costs. Policy change to reduce these barriers is critical to improve access to and experiences with second trimester abortion care.

Barriers to and Facilitators of Moving Miscarriage Management Out of the Operating Room.

CONTEXT: Miscarriage care can safely and effectively be offered in appropriately equipped offices and emergency departments. However, it is often treated in the operating room, which limits access to timely, cost-effective and high-quality care. METHODS: Between May 2013 and January 2014, in-depth interviews were conducted with 30 staff holding diverse roles at 15 medical offices and emergency departments with the aim of exploring barriers to and facilitators of offering miscarriage care, and identifying methods for expanding care. On-site observations were also conducted at four facilities. All data were transcribed, iteratively coded and analyzed using qualitative techniques. RESULTS: Similar barriers to and facilitators of providing miscarriage care were identified across facility types. Barriers were physician preference for providing care in the operating room, the similarity of miscarriage management and abortion procedures, the limited availability of support staff, difficulties integrating miscarriage management into patient scheduling and flow, and uncertainty about responding to women's emotional needs. Facilitators were a commitment to evidence-based medicine, insurance coverage of miscarriage, offering other procedures of similar complexity and the minimal resources needed for miscarriage care. Resources needed to expand miscarriage services included a medically trained "champion," best practices for implementing services, persistence and patience, training, clear protocols, and systems for tracking equipment and supplies. CONCLUSIONS: Miscarriage care was viewed as neither resource-intensive nor technically complex to provide. Although it may be emotionally and politically challenging to offer, effective strategies are available for expanding the scope of miscarriage care offered in multiple settings.