Characteristics associated with the adoption of consumer-based -self-sampling methods for sexually transmitted infection screening.

Objective: To identify theory-based innovation characteristics associated with the adoption of consumer-based self-sampling methods for sexually transmitted infection screening. Participants: Guided by the Diffusion of Innovation, survey data from people assigned female at birth (AFAB) (n = 92) were analyzed. Methods: Forward regression models and a path analysis were used to predict adoption by characteristics, using maximum likelihood estimation. Measures included acceptability, comfort, addresses healthcare needs, willingness to adopt self-sampling methods, and innovation characteristics. Results: Predictors of willingness to adopt were no clinic visit (relative advantage), convenient pick-up (relative advantage), and low cost. Variables with direct effects on adoption included: addresses healthcare needs, comfort, acceptability, and no clinic visit. Conclusions: Relative advantage was a salient factor and prioritizing this construct in intervention development may facilitate adoption. Results can guide the development of an innovative, theory-based intervention that promotes adoption of self-sampling methods, ultimately improving STI screening rates.

Christian Churches and the Prevention of Preadolescent Aggression and Violence in Puerto Rico: Regional Leaders' Perspective.

Preadolescents' involvement in religious congregations may serve as a distal protective factor against aggression. Interviews were conducted to explore Puerto Rico (PR) Christian church and faith-based organization (FBO) leaders' knowledge and perceptions about preadolescent violence, and the role of congregations in its prevention. Bullying was perceived as the most common type of aggression among PR preadolescents. Education, positive role modeling, and relationships with pro-social adults are considered important in its prevention. While willing to engage in violence prevention efforts, congregations may possess limited knowledge on the topic and its relevance. Findings can help inform the development of collaborative research and prevention efforts at the family and community levels.

Lactation Consultants' Perceived Barriers to Providing Professional Breastfeeding Support.

BACKGROUND: Addressing suboptimal breastfeeding initiation and duration rates is a priority in the United States. To address challenges to improving these rates, the voices of the providers who work with breastfeeding mothers should be heard. Research aim: The purpose of this study was to explore lactation consultants' perceived barriers to managing early breastfeeding problems. METHODS: This qualitative study was conducted with a grounded theory methodological approach. In-depth interviews were conducted with 30 International Board Certified Lactation Consultants across Florida. Lactation consultants were from a range of practice settings, including hospitals, Special Supplemental Nutrition Program for Women, Infants, and Children clinics, private practice, and pediatric offices. Data were digitally recorded, transcribed, and analyzed in Atlas.ti. RESULTS: A range of barriers was identified and grouped into the following categories/themes: indirect barriers (social norms, knowledge, attitudes); direct occupational barriers (institutional constraints, lack of coordination, poor service delivery); and direct individual barriers (social support, mother's self-efficacy). A model was developed illustrating the factors that influence the role enactment of lactation consultants in managing breastfeeding problems. CONCLUSION: Inadequate support for addressing early breastfeeding challenges is compounded by a lack of collaboration among various healthcare providers and the family. Findings provide insight into the professional management issues of early breastfeeding problems faced by lactation consultants. Team-based, interprofessional approaches to breastfeeding support for mothers and their families are needed; improving interdisciplinary collaboration could lead to better integration of lactation consultants who are educated and experienced in providing lactation support and management of breastfeeding problems.

The Impact of the Teen Outreach Program on Sexual Intentions and Behaviors.

PURPOSE: We evaluated the impact of a positive youth development program on adolescent pregnancy, sexual behavior, risky sex, and intentions in nonmetropolitan Florida high schools. METHODS: Between 2012 and 2014, the Teen Outreach Program (TOP) was compared to standard school curriculum content using a cluster randomized controlled trial design with 7,976 youth in two cohorts. The majority of youth were 14 years old and in the ninth grade at baseline. Treatment group youth received TOP in health-related classes. After using multiple imputation to account for missing data, we analyzed baseline and follow-up survey data using generalized linear mixed-effects models with logit link function. RESULTS: In the cohort 1 sample, compared to the control condition, males and females receiving TOP showed lower odds of engaging in recent sex (odds ratio [OR], .71; 95% confidence interval [CI]: .58-.86) compared to control males and females. Cohort 1 treatment females who did engage in recent sex were less likely to have risky sex (OR, .54; 95% CI: .32-.89). There were fewer significant findings in cohort 2, though TOP females and combined gender had lower odds of risky sex intentions (OR, .53; 95% CI: .33-.84 and OR, .65; 95% CI: .44-.96, respectively). Overall, cohort 1 females in the TOP condition were the group most likely to benefit from TOP. CONCLUSIONS: Consistent with previous research, TOP was more effective regarding sexual health outcomes among female versus male youth; this was especially true for the outcome of risky sex. However, results were not consistent across cohorts, prompting questions for future research.

Confusion about Pap smears: lack of knowledge among high-risk women.

BACKGROUND: The impact of the Papanicolaou (Pap) smear on the prevention of cervical cancer is one of the greatest public health success stories. However, it is not clear if women understand the purpose of the Pap smear despite recent advancements and national attention over cervical cancer prevention. The purpose of this study was to examine Pap smear knowledge among three high-risk populations at different points in time. METHODS: Women from three separate human papillomavirus (HPV) psychosocial studies completed surveys assessing Pap smear knowledge: (1) HPV-positive women (prevaccine population in 2005-2006, n=154, mean age 23.5), (2) college women (postvaccine population in 2008, n=276, mean age 18.9), and (3) minority college women (postvaccine population in 2011, n=711, mean age 23.3). Frequencies and logistic regression were employed to examine associations between demographic factors and accurate knowledge of Pap smear testing within each study. RESULTS: Approximately one quarter of participants across all three samples did not know that the Pap smear is a test for cervical cancer. Participants also incorrectly believed that the Pap smear tests for HPV (82%-91%), vaginal infections (76%-92%), yeast infections (65%-86%), gonorrhea (55%-81%), herpes (53%-80%), HIV/AIDS (22%-59%), and pregnancy (17%-38%). Among all three studies, older age was the only factor significant with higher Pap knowledge. Higher HPV knowledge scores were significantly associated with higher Pap knowledge in studies 2 and 3 only. CONCLUSIONS: Knowledge about the purpose of the Pap smear remains low. Findings underscore the significant need for clear and consistent messages among high-risk women regarding the prevention of cervical cancer and other reproductive health conditions.

Political contexts surrounding Title X, the national family planning program, over the past four decades: oral histories with key stakeholders in Florida.

INTRODUCTION: Title X, enacted in 1970, remains the only policy devoted solely to providing voluntary and confidential family planning and related preventative services to all those in need. Despite Title X's significant public health achievements, this policy continues to receive scrutiny and faces political, financial, and social challenges. This study explores key stakeholders' perceptions regarding the political contexts that have surrounded Title X over its historical maturation. METHODS: Six oral histories were conducted with key stakeholders in Florida using a semi structured interview guide developed from Title X's legislative history, McPhail's Feminist Policy Analysis Framework, and the literature. Oral histories were audio recorded, transcribed, and analyzed using open, axial, and selective coding in NVivo 8. RESULTS: Participants identified and discussed the following political topics and controversies that they perceived have directly or indirectly affected Title X: abortion, adolescents, parental notification, school-based clinics, abstinence-only education, political administrations, and family planning methods. DISCUSSION: Participants' recollections regarding the political contexts that have surrounded Title X over the past 4 decades provided a broad yet rich description of the barriers that exist with fulfilling this policy. Such opposition hinders Title X's ability to support women's right to reproductive health. Practitioners play a key role in advocating for family planning services and should understand the political issues hindering reproductive health policies and the need to translate family planning services as a basic human right.

The role of pharmacists and emergency contraception: Are pharmacists' perceptions of emergency contraception predictive of their dispensing practices?

BACKGROUND: Pharmacists can play a critical role in the access to emergency contraception (EC). We assessed if knowledge and attitudes were predictive of EC dispensing among a statewide sample of Florida pharmacists, who have legal authority to refuse to dispense medications. STUDY DESIGN: In 2008, surveys were mailed to a random sample of 1264 pharmacists registered with the Florida Board of Pharmacy. Data from 272 pharmacists (22% response rate) were analyzed using bivariate and multivariate logistic regression. RESULTS: Fifty-six percent of respondents incorrectly answered that EC causes birth defects, and 46% replied that it causes abortion. Only 22% said that EC can be purchased in advance of need. Many felt uncomfortable dispensing to adolescents (61%) and men (58%). Knowledge about EC was the most important predictor of dispensing [odds ratio (OR)=1.57, 95% confidence interval (CI) 1.22-2.03]. In particular, pharmacists who reported that EC does not act as an abortifacient were more likely to dispense it (OR=4.64, 95% CI 2.15-10.00). CONCLUSIONS: Correct information about EC was the most important predictor of pharmacists' dispensing EC. To expand availability of EC, pharmacists will have to become better informed.

Approaching 4 decades of legislation in the national family planning program: an analysis of Title X's history from 1970 to 2008.

Family planning is an important public health activity. Title X (Pub L No. 91-572), enacted in 1970, remains the only national family planning program in the United States dedicated to providing voluntary and confidential services to all individuals. We conducted a thematic analysis of Title X's legislative history. Of 293 federal bills included in the legislative history, only 20 (6.8%) were enacted into law. Regardless of the proposed challenges, limited changes have been adopted. Except for technical amendments, bills involving restrictions accounted for the highest percentage of enacted bills, demonstrating efforts to undermine reproductive health rights. Title X requires political will and bipartisan support if it is to continue to protect individuals' reproductive rights.