Effects of gender-transformative relationships and sexuality education to reduce adolescent pregnancy (the JACK trial): a cluster-randomised trial.

BACKGROUND: The need to engage boys in gender-transformative relationships and sexuality education (RSE) to reduce adolescent pregnancy is endorsed by WHO. We aimed to test an intervention which used a gender-transformative approach to engage adolescents in RSE to prevent unprotected sex. METHODS: This cluster-randomised trial with process and economic evaluations tested a school-based intervention entitled If I Were Jack versus standard RSE (control) for students (aged 14-15 years) in UK schools. Schools were randomly allocated (1:1) and masked to allocation at baseline. The primary outcome was self-reported avoidance of unprotected sex (sexual abstinence or use of reliable contraception at last sex) after 12-14-months. We analysed the data using intention-to-treat mixed effects regression models. FINDINGS: Of 803 schools assessed for eligibility, 263 schools were invited by letter, of which 66 schools agreed to be randomly assigned, of which 62 schools completed follow-up. The trial was done between Feb 1, 2018, and March 6, 2020. 8216 students participated at baseline in 2018; 6561 (79·85%) provided 12-14 months follow-up. There was no significant difference in the primary outcome of avoidance of unprotected sex: 2648 (86·62) of 3057 in the intervention group avoided unprotected sex versus 2768 (86·41%) of 3203 in the control group (adjusted odds ratio [aOR] 0·85 [95% CI 0·58-1·26], p=0·42). Exploratory post-hoc analysis of the two components of the primary outcome showed that significantly more intervention students used reliable contraception at last sex compared with control students and there was no significant difference between the groups for sexual abstinence. No adverse events were reported. INTERPRETATION: The intervention had a null effect on the primary outcome of preventing unprotected sex (increasing sexual abstinence or use of reliable contraception) in the whole student population. However, the results showed significant increases in use of reliable contraceptives for sexually active students. Engaging all young people early through RSE is important so that as they become sexually active, rates of unprotected sex are reduced. FUNDING: National Institute for Health Research.

Barriers to Self-Disclosing Level of Maternal Care: What Are Wisconsin Hospitals Worried About?

OBJECTIVE: The American College of Obstetrics and Gynecology (ACOG) has recommended every hospital disclose their level of maternal care (LOMC) to categorize the capabilities of their birthing center and regionalize perinatal care. Of the 98 birthing centers in Wisconsin, 44% have self-disclosed their LOMC. In many states, disclosing LOMC is mandated but, despite evidence and professional association recommendations, Wisconsin relies on voluntary self-reporting. We surveyed all birthing centers in Wisconsin to better understand the barriers to disclosing their LOMC. STUDY DESIGN: An anonymous survey was sent to all 98 birthing centers in Wisconsin. Survey recipients were hospital administrators, nursing supervisors, or physician directors of obstetric units. The survey sought information on perceived barriers to completing self-assessments and disclosing their hospital's LOMC. Quantitative descriptive statistics were used for data analysis. RESULTS: Of 98 birth centers in Wisconsin, 40 (40.8%) responded. Fifteen of the 40 responses were from birthing centers that have not yet disclosed their LOMC. Of these, 93% were unsure how to disclose, 73% found the paperwork confusing, and 80% did not have the time or staff to complete the paperwork. Respondents did not report lack of departmental support, concerns about losing business or reputation, or future physician recruitment as barriers. Of all respondents, 77.5% were aware of ACOG's LOMC recommendations, but only 35% thought disclosing their LOMC would be beneficial to maternal care. CONCLUSIONS: Birthing centers in Wisconsin need further guidance on how to complete a self-assessment of their LOMC. In order to increase self-disclosure of LOMC, statewide perinatal organizations will need to continue to emphasize the benefits of releasing this information. Organizations should also provide additional support to level 1 and 2 birthing centers and improve maternal and neonatal care overall.

Prenatal Racial Discrimination Associated With Dissatisfaction With Prenatal Care.

INTRODUCTION: Maternal and infant racial and ethnic health disparities persist in Wisconsin. The Black infant mortality rate is 3 to 4 times that of White infants. OBJECTIVE: In this study, we used data from the Wisconsin Pregnancy Risk Assessment Monitoring System to examine women's experiences with racism and accessing pre- and postnatal care. METHODS: Data from the 2016-2018 Pregnancy Risk Assessment Monitoring System-an ongoing state-administered surveillance system of new mothers-were used. The total number of non-White respondents was n = 2,571. The data are weighted both for nonsampling and for nonresponse. The prevalence of late entry to prenatal care, inadequate prenatal care, and no postpartum visit in the population of non-White women were calculated. Multivariable logistic regression was used to model the association between racial discrimination in the year prior to birth and perinatal care utilization and satisfaction. RESULTS: Less-than-adequate prenatal care was significantly associated with racial discrimination in bivariate analysis (OR 1.4; 95% CI, 1.02-1.8), but this relationship became marginally significant after adjusting for maternal sociodemographic characteristics (OR 1.3; 95% CI, 0.9-1.7). In contrast, prenatal experience of racial discrimination was associated with about 1.5 times the odds of not receiving a postpartum visit both before and after adjusting for maternal characteristics (OR 1.6; 95% CI, 1.1-2.3). CONCLUSIONS: Completing the postpartum visit has the potential to save mothers' lives; decreasing experiences of racial discrimination in health care settings may be one mechanism for decreasing maternal and infant mortality.

Differing views regarding diet and physical activity: adolescents versus parents' perspectives.

BACKGROUND: Today, approximately one in five United States adolescents age 12 to 19 years is obese and just over a third are either overweight or obese. This study examines how parents and peers influence diet and physical activity behaviors of older adolescents (14-18 years) with overweight or obesity to inform weight management interventions. METHODS: Adolescent participants included 14 to 18-year-olds with a Body Mass Index (BMI) greater than the 85th percentile for their age and sex who were receiving care in a large healthcare system in Northern California. Adolescents and their parents participated in separate focus groups and interviews (if not able to attend focus groups) that were held at the same time in the same location. We used qualitative thematic analysis to identify common themes discussed in the adolescent and parent focus groups as well as paired analysis of adolescent-parent dyads. RESULTS: Participants included 26 adolescents and 27 parents. Adolescent participants were 14 to 18 years old. Half were female and the participants were almost evenly distributed across year in school. The majority self-identified as White (56%) and Asian (36%).Three themes were identified which included 1) parents overestimated how supportive they were compared to adolescents' perception 2) parents and adolescents had different views regarding parental influence on adolescent diet and physical activity behaviors 3) parents and adolescents held similar views on peers' influential role on lifestyle behaviors. CONCLUSION: Parents' and adolescents' differing views suggest that alignment of parent and adolescent expectations and behaviors for supporting effective weight management could be incorporated into interventions.

"I don't want to be Henrietta Lacks": diverse patient perspectives on donating biospecimens for precision medicine research.

PURPOSE: To determine whether patients distinguish between biospecimens and electronic health records (EHRs) when considering research participation to inform research protections. METHODS: We conducted 20 focus groups with individuals who identified as African American, Hispanic, Chinese, South Asian, and non-Hispanic white on the collection of biospecimens and EHR data for research. RESULTS: Our study found that many participants did not distinguish between biospecimens and EHR data. However, some participants identified specific concerns about biospecimens. These included the need for special care and respect for biospecimens due to enduring connections between the body and identity; the potential for unacceptable future research, specifically the prospect of human cloning; heightened privacy risks; and the potential for unjust corporate profiteering. Among those who distinguished biospecimens from EHR data, many supported separate consent processes and would limit their own participation to EHR data. CONCLUSION: Considering that the potential misuse of EHR data is as great as, if not greater than, for biospecimens, more research is needed to understand how attitudes differ between biospecimens and EHR data across diverse populations. Such research should explore mechanisms beyond consent that can address diverse values, perspectives, and misconceptions about sources of patient information to build trust in research relationships.

Turning the ship: making the shift to a life-course framework.

Turning a ship requires small but steady and deliberate efforts over time. During the past 9 years, Wisconsin's Maternal and Child Health (MCH) Program has begun to utilize the life-course perspective as its framework for guiding efforts around women's health, early childhood systems, children and youth with special health care needs, chronic disease integration, and elimination of racial and ethnic disparities in birth outcomes. In collaboration with many state and national partners, Wisconsin's MCH Program has integrated the life-course perspective into efforts that include the following: increasing professional and public awareness of the framework; creating focus groups and social marketing campaigns in communities most affected by health disparities; expanding preconception and women's health initiatives; integrating with traditionally "non-MCH" programs such as chronic disease programs; and shifting Title V resources from provision of individual services to assurance of effective early childhood systems. Wisconsin's implementation of the life-course perspective has not been without challenges, but opportunities have also been identified along the journey. Initial efforts focused on training and supporting partners in their understanding and application of the life-course framework, and a train-the-trainer model was discovered to be key to achieving these goals. We took care to engage special populations and their advocates and to work closely with local communities. We hope that the lessons we have learned in this process will provide guidance for others as they work to incorporate life course into their MCH work. The life-course perspective has helped us to inform partners, policy makers, and funders of the need for a new approach in addressing racial and ethnic disparities in health.

Experiences of immigrant women who self-petition under the Violence Against Women Act.

Undocumented immigrant women who are abused and living in the United States are isolated in a foreign country, in constant fear of deportation, and feel at the mercy of their spouse to gain legal status. To ensure that immigration law does not trap women in abusive relationships, the Violence Against Women Act (VAWA, 1994) enabled immigrant women to self-petition for legal status. Qualitative research methods were used in this participatory action research to investigate the experiences of Mexican immigrant women filing VAWA self-petitions. Emotional, financial, and logistic barriers in applying are identified, and recommendations for practice research and policy are provided.

Influences on visitor behavior at a modern immersive zoo exhibit.

Zoos serve as centers for both research and education. The challenge is to convey messages about their conservation projects while meeting visitor expectations, which often include recreation and entertainment. One way this can be achieved is through the design of immersive exhibits that draw visitors in and engage them with interactive educational elements. Regenstein African Journey (RAJ) opened at Lincoln Park Zoo in 2003 and was designed to take visitors on a simulated safari through Africa. Because visitor experience was a major design goal, we conducted a timing and tracking study to evaluate use of the building and educational components. For a 9-week period in 2003, we tracked 338 visitors to RAJ and recorded continuous data as they moved through the building. Data were collected on handheld computers that provided precise timing data. The median visit was 11.08 min, 41% of which was spent looking at animals and 9% of which was spent engaged with interpretive elements. We found significant differences in the way visitors used signage: those in groups without children spent more of their visit engaged with signage than those with children and visitors who spent more of their visit interacting socially spent less time engaged with signage. By understanding how visitors use the educational opportunities presented to them, we can better meet their expectations and more effectively achieve the goal of conservation education.