ArtSpective™ for Perinatal Substance Use: Feasibility of an Arts-Based Intervention Addressing Stigma.

OBJECTIVE: The purpose of this proof-of-concept pilot study was to test the initial feasibility and limited efficacy of ArtSpective™ for perinatal substance use (PSU), a novel, arts-based intervention designed to decrease stigmatizing attitudes toward PSU. METHODS: Using a pre-post mixed methods quasi-experimental design, ArtSpective™ for PSU was pilot tested for proof of concept among a convenience sample of 11 undergraduate and graduate students with experience in maternal-infant nursing from a Midwestern U.S. nursing school. As a proof-of-concept pilot study, we evaluated feasibility (acceptability, demand, and implementation) and limited efficacy. Participants completed presurveys and postsurveys that included satisfaction items, demographic items, and an adapted version of the Attitudes About Drug Use in Pregnancy Scale and participated in a focus group. Focus group data were analyzed using constant comparative methods, and survey data were analyzed using descriptive statistics and Wilcoxon signed rank tests. RESULTS: Participants reported high demand and satisfaction with the intervention and provided recommendations to improve scalability. ArtSpective™ demonstrated significant improvement in stigma toward PSU (pre vs. post: p = .003; d = .633). CONCLUSION: ArtSpective™ for PSU demonstrated initial feasibility and limited efficacy for improving nurse attitudes toward PSU. Efforts are needed to further test this novel intervention, adapt it to augment existing educational interventions, and improve its scalability.

Associations of sexual identity change and identity-attraction discordance with symptomatic alcohol and other drug use.

PURPOSE: National studies examining alcohol and other drug use by sexual orientation have been primarily cross-sectional. Understanding changes in sexual orientation over time may further elucidate the mechanisms behind sexual orientation differences in alcohol and other drug use. This national longitudinal study examines changes in sexual orientation across four waves (2013-2019), and the associations with symptomatic alcohol and other drug use. METHODS: Data from Waves 1 through 5 of the Population Assessment of Tobacco and Health (PATH) study were used to examine associations of sexual identity change/stability and sexual identity-attraction discordance/concordance from baseline to follow-up with symptomatic substance use at follow-up. We examined four outcomes: any symptomatic substance use, symptomatic alcohol use, symptomatic other drug use, and symptomatic alcohol + other drug use. Mixed effects logistic regression models were used and all analyses were weighted and stratified by sex. RESULTS: In models adjusting for potential confounders, greater likelihood of symptomatic alcohol and other drug use outcomes was found among males and females experiencing a change from a heterosexual to sexual minority identity and among females with new or consistent sexual identity-attraction discordance. CONCLUSION: These findings highlight important sex differences and suggest that the period of transitioning to a sexual minority identity is a particularly vulnerable period for symptomatic alcohol and other drug use. For females, incongruent sexual identity and attraction is also a risk factor. Interventions that assist individuals during this transitional period and during a time when identity and attraction are incongruent, may reduce symptomatic substance use during this period.

Effectiveness of take ACTION online naloxone training for law enforcement officers.

BACKGROUND: Training law enforcement officers (LEOs) to administer naloxone is a recommended strategy to reduce overdose deaths in the United States. To achieve this, an evidence-based and scalable naloxone training curriculum that is easy to use and readily scalable is needed. Convenient web-based training is a flexible method for delivering educational interventions particularly for LEOs who have irregular or shifting schedules. This study examined the effectiveness of a comprehensive web-based naloxone training that was created in partnership with LEOs on their knowledge, confidence, and attitudes regarding naloxone. METHODS: From May 2019 to September 2020, five law enforcement departments from Michigan participated in web-based naloxone training. A total of 182 LEOs (77% male) were in the final sample based on matching pre-and post-test surveys. LEOs were assessed on knowledge, confidence, and attitudes towards naloxone. Negative binomial and Poisson regression was conducted to assess associations between knowledge, confidence, and attitudes towards naloxone before and after training. RESULTS: Significant improvements in overdose knowledge and confidence were revealed across all departments with median (IQR) total composite scores for knowledge increasing from 35 (32, 37) to 40 (39, 42) (p < 0.01) and confidence increasing from 18.5 (15, 20) to 20 (20, 25) (p < 0.01). Median (IQR) attitude scores did not change. CONCLUSION: Our web-based naloxone training was effective in improving knowledge and confidence for LEOs but did not significantly improve LEOs attitudes towards naloxone across most departments. The web-based format is readily scalable and quickly disseminated and meets the immediate need for LEO overdose training. Additional intervention is needed to address the negative attitudes of LEOs regarding naloxone.

Ethnic Discrimination, Sexual Orientation Discrimination, and DSM-5 Alcohol Use Disorder Among U.S. Latino or Hispanic Adults.

We aimed to assess the probability of past-year DSM-5 alcohol use disorder (AUD) and past-year moderate-to-severe DSM-5 AUD as a function of past-year ethnic discrimination among U.S. Latino/Hispanic adults and as a function of past-year discrimination types among Latino/Hispanic sexual minorities (SM). We used data from the 2012-2013 National Epidemiological Survey on Alcohol and Related Conditions-III (n = 36,309 U.S. adults aged ≥18 years). Our sample consisted of 6,954 Latino/Hispanic adults. Multivariable logistic regression analyses estimated the association of past-year ethnic discrimination with past-year AUD and past-year moderate-to-severe AUD among the overall Latino/Hispanic population. We tested the association between discrimination types (i.e. none, ethnic or sexual orientation discrimination, both) with AUD and moderate-to-severe AUD among Latino/Hispanic SM adults. Among Latino/Hispanic adults, 13.4% met criteria for past-year AUD and 6.4% met criteria for past-year moderate-to-severe AUD. Ethnic discrimination was significantly associated with AUD (AOR = 1.09, 95% CI = 1.07-1.12) and moderate-to-severe AUD (AOR = 1.10, 95% CI = 1.06-1.13). Latino/Hispanic SMs who experienced both ethnic and sexual orientation discrimination were more likely to meet criteria for AUD (AOR = 3.44, 95% CI = 1.97-6.03) and moderate-to-severe AUD (AOR = 2.69, 95% CI = 1.25-5.82) compared to those who did not experience discrimination. Discrimination is a risk factor for AUD and moderate-to-severe AUD among Latino/Hispanic overall and SM populations.

Racial/Ethnic Disparities in Mental Healthcare in Youth With Incarcerated Parents.

INTRODUCTION: Youth with incarcerated parents experience more adverse childhood experiences than other youth, placing them at higher risk for mental health and substance use disorders. Despite their increased risk, these youth may be less likely to access mental health services, particularly given their racial and ethnic makeup. Therefore, this study aimed to assess racial and ethnic disparities in access to mental health services for youth with incarcerated parents. METHODS: This secondary data analysis used longitudinal data from 2016 to 2019 from the Adolescent Brain Cognitive Development Study. Logistic regression models assessed the relationships among incarceration, cumulative childhood experiences, DSM-5 diagnoses, and mental health services. Additional analyses stratified these models by race and ethnicity. All analyses were performed in 2022. RESULTS: Youth with incarcerated parents were more likely to report 4 or more childhood experiences (51% vs 14%; AOR=3.92; 95% CI=3.3, 4.65; p<0.001) and to have received mental health services (25% vs 15%; AOR=1.89; 95% CI=1.6, 2.21; p<0.001) than unexposed youth. However, Black youth with incarcerated parents (19% vs 34%; AOR=0.38; 95% CI=0.27, 0.52; p<0.001) and Latinx youth with incarcerated parents (10% vs 17%; AOR=0.5; 95% CI=0.33, 0.76; p<0.001) were significantly less likely to report receiving mental health services than White youth with incarcerated parents and non-Latinx youth with incarcerated parents, respectively. CONCLUSIONS: Youth with incarcerated parents were more likely to report utilization of mental health services, but significant racial and ethnic disparities exist between Black and Latinx youth with incarcerated parents compared with that among White and non-Latinx youth with incarcerated parents. There is a continued need to expand mental health services to youth with incarcerated parents and to address racial and ethnic disparities in access to care.

Examining sexual identity stability and change over time and associations with tobacco use in a nationally representative US sample.

BACKGROUND: Epidemiologic research has found sexual minority identifying individuals are disproportionately burdened by tobacco use and tobacco use disorder (TUD). However, these studies often conceptualize sexual identity as time-invariant. This study examined sexual identity over time and whether a transition to a sexual minority identity was associated with tobacco outcomes. METHODS: This study used data from Waves 1-4 of the Population Assessment of Tobacco and Health (2013/14-2016/18) study (adolescents and adults aged ≥ 14 years; n = 26,553). We examined associations of sexual identity stability and change with changes in the number of tobacco products used and TUD symptoms. RESULTS: Males and females who experienced two or more changes in sexual identity and females who changed from a heterosexual to a sexual minority identity were more likely to have an increase in two or more tobacco products and increase TUD symptoms compared to heterosexual-stable males and females. Gay-stable males were less likely to increase TUD symptoms compared to heterosexual-stable males. CONCLUSIONS: Experiencing a change in sexual identity may be a particularly vulnerable period for increases in tobacco products used and TUD. It may be important to provide tobacco use intervention and support resources to individuals coming out as a sexual minority and those fluid in their sexual identity.

A Risk Education Program Decreases Leftover Prescription Opioid Retention: An RCT.

INTRODUCTION: Retaining leftover prescription opioids poses the risks of diversion, misuse, overdose, and death for youth and other family members. This study examined whether a new educational program would enhance risk perceptions and disposal intentions among parents and decrease their retention of leftover prescription opioids. STUDY DESIGN: This study is an RCT (NCT03287622). SETTING/PARTICIPANTS: A total of 648 parents whose children were prescribed opioid analgesics were recruited from a Midwestern, academic pediatric hospital between 2017 and 2019. Parents were randomized to receive routine information (control) with or without Scenario-Tailored Opioid Messaging Program intervention. INTERVENTION: The intervention provided opioid risk and mitigation advice using interactive decisional feedback. MAIN OUTCOME MEASURES: The main outcome measures were parents' perceptions of the riskiness of keeping/sharing opioids and child misuse measured at baseline, Days 3 and 14, their intention to dispose of leftover opioids, and their final retention decisions after the child's use (at or around Day 14). RESULTS: Perceived riskiness of child misuse and keeping/sharing opioids increased from baseline through Day 14 only for parents in the intervention group (p≤0.006). However, there were no significant differences in risk perceptions between groups and no intervention effect on disposal intentions at either follow-up. Despite these findings, the intervention reduced the likelihood of parents' opioid retention when adjusted for important parent and child covariates (AOR=0.48; 95% CI=0.25, 0.93; p=0.028). Parents who reported past opioid misuse also showed higher retention behavior (AOR=4.78; 95% CI=2.05, 11.10; p<0.001). CONCLUSIONS: A scenario-specific educational intervention emphasizing the potential risks that leftover opioids pose to children and that provided risk mitigation advice decreased parents' retention of their child's leftover opioid medication. Removing leftover prescription drugs from homes with children may be an important step to reducing diversion, accidental poisoning, and misuse among youth. TRIAL REGISTRATION: This study is registered at www. CLINICALTRIALS: gov NCT03287622.

Is it all in the family? Sexual identity differences in DSM-5 alcohol and other drug use disorders and associations with alcohol and other drug misuse history among parents, offspring, and other relatives.

Background: The objectives of this study were to: (1) estimate the prevalence of family history of alcohol and other drug (AOD) misuse (positive family history [FH+]) in first- and second-degree relatives across sexual identity subgroups (i.e., lesbian, gay, bisexual, heterosexual); (2) compare AOD misuse among offspring of sexual minority and heterosexual parents; and (3) examine the relationships between FH+ and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) alcohol use disorder (AUD) and other drug use disorder (ODUD) across sexual identity subgroups. Methods: Data were from the National Epidemiologic Survey on Alcohol and Related Conditions-III (n = 36,309 non-institutionalized U.S. adults aged ≥ 18 years). Data collection occurred in households using structured diagnostic face-to-face interviews during 2012-2013. Results: The presence of FH+ in first- and second-degree relatives was most prevalent among bisexual women relative to all other sexual orientation subgroups. Multivariable regression analyses indicated that the odds of AUD and ODUD were higher among FH+ adults relative to negative family history (FH-) adults. Lesbian and bisexual women had higher odds of AUD compared to heterosexual women, controlling for any FH+; this sexual identity difference was not found for men. There were no significant differences in ODUD between heterosexual FH- men and gay FH- men. We found differences in AOD misuse among offspring of bisexual parents, but not gay or lesbian parents compared to heterosexual parents. Conclusions: Health professionals should consider the higher likelihood of a family history of AOD misuse among sexual minorities, especially bisexual women, when treating these individuals. The lack of differences in AOD misuse among offspring of gay or lesbian parents relative to heterosexual parents warrants attention for legal, policy, and clinical decisions.

Law Enforcement Perceptions About Naloxone Training and Its Effects Post-Overdose Reversal.

BACKGROUND: Law enforcement officers (LEOs) often are the first responders to arrive at a scene of an opioid overdose. Thus, equipping LEOs as first responders with naloxone is necessary to prevent overdose deaths and a recommended strategy. However, little is known about how LEOs perceive naloxone training and their feelings after using naloxone to save a life. It is important to understand LEOs' experiences with naloxone so as to develop additional training materials that are relevant to the LEO experience. METHODS: A descriptive exploratory study was conducted to explore the perceptions of LEOs about using naloxone in the field and to identify areas that should be included in future naloxone trainings. Interview data were obtained through face-to-face interviews with LEOs (N = 14) and analyzed using manifest content analysis. RESULTS: LEOs changed their attitudes and beliefs toward naloxone after receiving training and experiencing a successful resuscitation. The change in attitudes was enhanced after saving a life. However, misconceptions about naloxone and lack of understanding about disease of addiction persisted even after training. CONCLUSION: Future naloxone curriculum could benefit from additional lessons on the stigma of addiction, the disease of addiction, misconceptions about the safety of naloxone, strategies for postoverdose responses, and the role naloxone, which might play in a hopeful recovery.

Tobacco Use Among Gender-Varying and Gender-Stable Adolescents and Adults Living in the United States.

INTRODUCTION: This study examines the proportion of the United States adolescents and adults who are variable (ie, at least one change in gender identity) versus stable in their gender identities over time, and whether they differ significantly in their nicotine/tobacco use after adjusting for key covariates. METHODS: We fit multivariable logistic regression models to data from Waves 2-4 (2014/15-2016/18) of the Population Assessment of Tobacco and Health (PATH), a nationally representative study (n = 33 197 U.S. adolescents and adults aged ≥14 years). We examined associations of gender stability/variability over three waves with tobacco use at wave 4 (2016-2018). Differences in any past 30-day tobacco, cigarette, e-cigarette, other tobacco, and poly-tobacco use were assessed among cisgender-stable, transgender-stable, and gender-varying respondents. RESULTS: An estimated 1.0% of adolescents and adults were classified as gender-varying. Prevalence of any past 30-day tobacco use was higher among gender-varying individuals (42.7%) than among gender-stable individuals (transgender-stable, 37.8% and cisgender-stable, 26.7%). There were no significant differences in the odds of nicotine/tobacco use between the two gender-stable groups. However, gender-varying respondents had significant increased odds of any past 30-day tobacco use (adjusted odds ratio [AOR] = 2.0, 95% confidence interval [CI] = 1.3 to 3.0), cigarette use (AOR = 1.7, 95% CI = 1.1 to 2.5), e-cigarette use (AOR = 2.2, 95% CI = 1.4-3.5), other tobacco use (AOR = 2.2, 95% CI = 1.4 to 3.4), and poly-tobacco use (AOR = 2.0, 95% CI = 1.3 to 3.1) compared with cisgender-stable individuals. CONCLUSIONS: Gender-varying individuals are at higher risk for nicotine/tobacco use, placing them at greater risk for tobacco-related health consequences. IMPLICATIONS: Despite increased knowledge about transgender health in recent years, there remains a paucity of research about gender-varying individuals. This study is the first to examine the proportion of gender-varying individuals in the United States using a longitudinal, nationally representative sample and to explore differences in nicotine/tobacco use among gender-varying and gender-stable individuals. Our findings suggest that gender-varying people have an increased risk for nicotine/tobacco use, placing them at higher risk for tobacco-related health consequences. This study increases knowledge about nicotine/tobacco use among this under-represented population in research and underscores the importance of developing an awareness of gender diversity.

Mental health-related quality of life by sex and sexual identity among U.S. adults with alcohol and tobacco use disorder.

INTRODUCTION: Alcohol use disorder (AUD) and tobacco use disorder (TUD) are more severe among some sexual minority subgroups. It is less understood whether mental health indicators also differ by sexual identity among those with more severe forms of AUD and TUD. We examined differences in mental health-related QoL by sex-specific sexual identity subgroup among those meeting criteria for moderate-to-severe AUD or moderate-to-severe TUD. METHODS: We analyzed data from the National Epidemiologic Study of Alcohol and Related Conditions-III (2012-2013; n = 36,309). Our analyses focused on those meeting criteria for past-year moderate-to-severe AUD (n = 2341) and past-year moderate-to-severe TUD (n = 3675). Using multivariable linear regression, we examined associations of sex-specific sexual identity subgroups with mental health-related QoL, while controlling for (a) sociodemographic characteristics, (b) disorder severity, and (c) risk and protective factors (adverse childhood experiences, parental history of substance misuse, stressful life events, and social support). RESULTS: Among those with past-year moderate-to-severe AUD, gay men and heterosexual, bisexual, and gay/lesbian women had significantly lower mental health-related QoL compared to heterosexual men in fully adjusted models. Among those with past-year moderate-to-severe TUD, gay men and heterosexual and gay/lesbian women had significantly lower mental health-related QoL compared to heterosexual women. Bisexual and heterosexual women were not significantly different in fully adjusted models. DISCUSSION: Clinicians should consider the variability in mental health-related QoL among those with moderate-to-severe AUD and TUD particularly for women and sexual minorities. Consideration of current and past stressors and the degree of social support may be beneficial when conducting assessments and forming treatment plans.

Validity and Reliability of the Modified Attitudes About Drug Use in Pregnancy Scale.

OBJECTIVE: To contemporize the Attitudes About Drug Abuse in Pregnancy questionnaire, keep the length of the modified scale brief to promote use, and test the psychometric properties of the modified scale among perinatal nurses. DESIGN: Cross-sectional survey. SETTING: Four hospitals in the Midwestern United States. PARTICIPANTS: Registered nurses who worked in perinatal units (N = 440). METHODS: We collected data from participants using survey methods. Seven experts in perinatal substance use research and clinical care informed scale modifications. We used a split-sample design involving maternal-newborn units (labor, postpartum) and newborn-focused units (NICU, pediatrics). We evaluated construct validity using factor analysis and reliability using Cronbach's alpha. We tested for differences between units using analysis of variance and Tukey's post hoc honest significant difference test of pairwise differences. RESULTS: The final modified scale included 13 items that loaded on one factor and showed internal consistency reliability in both samples (α = .88-.91). We found a statistically significant difference in mean score between NICU and pediatric units; however, the absolute difference was small and likely not clinically significant. CONCLUSIONS: The Modified Attitudes About Drug Use in Pregnancy scale has initial evidence for validity and reliability, was updated to reflect current terminology in the field, and is a pragmatic tool for use in research.

Enhancing risk perception may be insufficient to curtail prescription opioid use and misuse among youth after surgery: A randomized controlled trial.

OBJECTIVE: This randomized controlled trial examined whether an interactive, risk-focused educational program was associated with higher risk perceptions and decreased prescription opioid use/misuse among emerging adults. METHODS: 503 participants aged 15-24 years scheduled for ambulatory surgery were randomized to routine prescription education with or without our Scenario-Tailored Opioid Messaging Program (STOMP) provided prior to receipt of a prescribed opioid. Surveys were completed preoperatively, and at days 7&14, months 1&3 postoperatively. Outcomes included analgesic risk perceptions, opioid use, and misuse intentions/behavior. RESULTS: Compared to Controls, STOMP was associated with stable but higher risk perceptions on day 14 (ß = 1.76 [95% CI 0.53, 2.99], p = .005) and month 3 (ß = 2.13 [95% CI 0.86, 3.40], p = .001). There was no effect of STOMP or analgesic misuse risk perceptions on days of opioid use or subsequent misuse intentions/behavior. The degree to which participants valued pain relief over analgesic risk (trade-off preference) was, however, associated with prolonged postoperative opioid use and later misuse. CONCLUSION: Education emphasizing the risks of opioids was insufficient in reducing opioid use and misuse in youth who were prescribed these analgesics for acute pain relief. PRACTICE IMPLICATIONS: Education may need to better address analgesic expectations to shorten opioid use and mitigate misuse.

An examination of how e-cigarette/cigarette use during adolescence is associated with future use during the third trimester of pregnancy.

Background: Adolescent e-cigarette use has increased, as has e-cigarette use during pregnancy, yet little is known about how these types of tobacco/nicotine (cigarettes/e-cigarettes) use during adolescence are associated with tobacco/nicotine use during the third trimester of pregnancy among young adults. Methods: National longitudinal data (2013-2018) from the Population Assessment of Tobacco and Health (PATH) study were used. Young adults ages 18-20 who indicated past-year pregnancy made up the analytic sample (N = 246). Logistic regression was used to evaluate the association between history of past 30-day use of cigarettes/e-cigarettes during adolescence (i.e., 14-17) and later use during the third trimester of pregnancy among young women (i.e., 18-20). Results: Within the sample of young women who indicated a pregnancy during the past year, 18.9% indicated smoking cigarettes and 4.2% indicated using e-cigarettes during their last trimester. Cigarette smoking in adolescence (wave 1 or 2) was associated with cigarette use during the last trimester (aOR = 4.76, 95% CI = 1.36, 16.6); however, e-cigarette use during adolescence was not associated with either cigarette or e-cigarette use during the third trimester of pregnancy. Conclusions: Tobacco/nicotine prevention in early adolescence has implications for preventing tobacco/nicotine-related harms during pregnancy among young adults. Intervention programs and clinicians informed about various types of tobacco/nicotine are needed to address tobacco/nicotine cessation among adolescents to prevent consequences of tobacco/nicotine use during pregnancy.

Sexual orientation differences in childhood sexual abuse, suicide attempts, and DSM-5 alcohol, tobacco, other drug use, and mental health disorders in the US.

BACKGROUND: Childhood sexual abuse (CSA) contributes to increased risk of substance use and mental health disorders in the general population. OBJECTIVE: To assess the prevalence and associations of CSA and suicide attempts, substance use, and mental health disorders as a function of sex (female, male) and sexual orientation (lesbian, gay, bisexual, heterosexual-identified with same-sex attraction and/or behavior, heterosexual-identified without same-sex attraction and/or behavior, and unsure). PARTICIPANTS AND SETTING: Data were collected using structured diagnostic face-to-face interviews in a nationally representative sample of 36,309 US adults. METHODS: We used descriptive statistics and logistic regression modeling to analyze data from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III). RESULTS: Childhood sexual abuse was most prevalent among sexual minorities, especially bisexual females. Nearly one-third of bisexual females (30.6%) reported experiencing two or more types of CSA, p < .001. Among all participants, exposure to one or more types of CSA was associated with greater odds of lifetime suicide attempts, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) alcohol, tobacco or other drug use disorder, and mental health disorders, after adjusting for other childhood adversity/maltreatment and general life stressors. CONCLUSIONS: Sexual minority females and males in the US are more likely than their heterosexual counterparts to report CSA. Higher risk of suicide attempts and DSM-5 alcohol, tobacco, other drug use, and mental health disorders in adulthood was directly associated with CSA, particularly among bisexual females. Health professionals working with individuals who have experienced CSA should assess these risks and intervene as needed.

Adolescents' Nicotine/Tobacco Dependency Symptoms Using 4 Waves of PATH Data.

Objective: We aimed to characterize male and female adolescents' use of e-cigarettes, cigarettes and dual use, and seven symptoms of nicotine/tobacco dependence using four waves of national data from the Population Assessment of Tobacco and Health (PATH) Study. Methods: The analytic sample included 2902 adolescents 12-17 years who indicated past 30-day e-cigarette or cigarette use at least once between 2013-2018. Items from the Wisconsin Inventory of Smoking Dependence Motives (WISDM-68) were used to report dependence symptoms. Results: Compared to cigarette users, exclusive e-cigarette users reported fewer symptoms of nicotine dependency. There were no differences between males and females and the odds of any reported dependency symptom. Among cigarette only users, the odds of indicating that their tobacco use helps them think better (adjusted odds ratio (AOR) = 2.38, 95% confidence interval (CI) = 1.08, 5.23) and wanting tobacco after waking up (AOR = 5.50, 95% CI = 1.10, 27.5) was higher among females when compared to males. Conclusions: The current study extends earlier findings regarding subgroup differences in nicotine/tobacco dependency symptoms participating in the PATH Study and highlights the importance of identifying nicotine/tobacco dependency symptoms when counseling adolescent males and females.

If we build it, will they come? Results of a quasi-experimental study assessing the impact of maternity waiting homes on facility-based childbirth and maternity care in Zambia.

INTRODUCTION: Maternity waiting homes (MWHs) aim to increase access to maternity and emergency obstetric care by allowing women to stay near a health centre before delivery. An improved MWH model was developed with community input and included infrastructure, policies and linkages to health centres. We hypothesised this MWH model would increase health facility delivery among remote-living women in Zambia. METHODS: We conducted a quasi-experimental study at 40 rural health centres (RHC) that offer basic emergency obstetric care and had no recent stockouts of oxytocin or magnesium sulfate, located within 2 hours of a referral hospital. Intervention clusters (n=20) received an improved MWH model. Control clusters (n=20) implemented standard of care. Clusters were assigned to study arm using a matched-pair randomisation procedure (n=20) or non-randomly with matching criteria (n=20). We interviewed repeated cross-sectional random samples of women in villages 10+ kilometres from their RHC. The primary outcome was facility delivery; secondary outcomes included postnatal care utilisation, counselling, services received and expenditures. Intention-to-treat analysis was conducted. Generalised estimating equations were used to estimate ORs. RESULTS: We interviewed 2381 women at baseline (March 2016) and 2330 at endline (October 2018). The improved MWH model was associated with increased odds of facility delivery (OR 1.60 (95% CI: 1.13 to 2.27); p<0.001) and MWH utilisation (OR 2.44 (1.62 to 3.67); p<0.001). The intervention was also associated with increased odds of postnatal attendance (OR 1.55 (1.10 to 2.19); p<0.001); counselling for family planning (OR 1.48 (1.15 to 1.91); p=0.002), breast feeding (OR 1.51 (1.20 to 1.90); p<0.001), and kangaroo care (OR 1.44 (1.15, 1.79); p=0.001); and caesarean section (OR 1.71 (1.16 to 2.54); p=0.007). No differences were observed in household expenditures for delivery. CONCLUSION: MWHs near well-equipped RHCs increased access to facility delivery, encouraged use of facilities with emergency care capacity, and improved exposure to counselling. MWHs can be useful in the effort to increase delivery at advanced facilities in areas where substantial numbers of women live remotely. TRIAL REGISTRATION NUMBER: NCT02620436.

Cigarette, e-cigarette, and dual use during the third trimester of pregnancy in a national sample of heterosexual and sexual minority women.

BACKGROUND AND OBJECTIVES: Research investigating e-cigarettes/e-products and dual use with cigarettes among pregnant sexual minority individuals in the United States is lacking. This study addresses this gap using a national sample. METHODS: Two waves of national panel data (2015-2018) from the Population Assessment of Tobacco and Health study were used. The sample included 1842 women, 237 identified as sexual minorities (n = 17 lesbian, n = 177 bisexual, n = 43 something else), who indicated pregnancy during the past 12 months at Waves 3 or 4. Covariates included race, ethnicity, past-year income, and education. Cigarette, e-cigarette, or dual use was examined during the last trimester. RESULTS: Sexual minorities had higher adjusted odds of cigarette use during their last trimester of pregnancy relative to heterosexual women (adjusted odds ratio [AOR] = 1.55, 95% confidence interval [CI] = 1.08, 2.23). Bisexual women had higher odds of smoking cigarettes during their third trimester compared with heterosexual women (AOR = 1.82, 95% CI = 1.21, 2.72). Lesbian women were more likely to use e-cigarettes/e-products (AOR = 9.15, 95% CI = 2.29, 36.5) and indicate dual use (AOR = 6.00, 95% CI = 1.43, 25.1) during their third trimester of pregnancy compared with heterosexual women. CONCLUSION AND SCIENTIFIC SIGNIFICANCE: Maternal health among US sexual minority women would benefit from clinicians equipped to provide accurate information and support for Food and Drug Administration-approved smoking cessation, information about e-cigarettes/e-products, and dual use. This study is the first to examine cigarette, e-cigarette, and dual use during the third trimester of pregnancy using a national sample, with specific attention to differences in sexual orientation.

Sexual identity differences in biomarkers of tobacco exposure among women in a national sample.

BACKGROUND: Sexual minority women are consistently at increased risk for tobacco use compared to heterosexual women. Neither biomarkers of nicotine exposure nor biomarkers of tobacco toxicant exposure have been examined by sexual identity. METHODS: This study used interview and biomarker data from women in the biomarker core sample of Wave 1 of the Population Assessment of Tobacco and Health (PATH) study (2013-2014; n = 4930). We examined associations of sexual identity with nicotine exposure (measured with urinary cotinine and TNE-2) and with tobacco-specific nitrosamines (measured with urinary NNAL). Multivariable regression modeling was used to examine these associations among the full biomarker core sample, among past 30-day tobacco users, and among exclusive established cigarette users before and after controlling for tobacco use quantity and intensity. RESULTS: In the full biomarker sample of women, prior to adjusting for tobacco use quantity and intensity, bisexual women had significantly higher cotinine, TNE-2, and NNAL levels compared to heterosexual women. Among exclusive established cigarette users, gay/lesbian women had significantly higher NNAL compared to heterosexual women prior to adjusting for tobacco quantity and intensity. No differences by sexual identity were found after adjusting for tobacco use quantity and intensity. CONCLUSIONS: This is the first study to demonstrate differences in biological markers of tobacco exposure by sexual identity among women in the U.S. This has important public health implications as greater exposure to both nicotine and to tobacco-specific nitrosamines are strongly linked to cancer risk.

High Prevalence of Low Birth Weight Babies Born to Pregnant Women Referred to a District Hospital in Rural Zambia.

OBJECTIVES: Low birthweight (LBW) is a significant public health problem in sub-Saharan Africa and LBW in rural Zambia is high. Our study explored the prevalence of LBW for newborns whose mothers were referred from a rural health center to a district referral hospital in Lundazi, Zambia. METHODS: A five-month retrospective record review of Ministry of Health data was performed to examine birthweight characteristics of a convenience sample of newborns from ten facilities referring to one district hospital (n = 234). RESULTS: Among all cases, 21% (n = 49) of newborns were LBW. For LBW newborns, 73% (n = 36) were preterm with mothers having a pregnancy duration of less than 37 weeks. Newborns whose mothers experienced twin pregnancies (p = .021) and prolonged labor (p = .033) were more often LBW. However, regression models demonstrated no difference among newborns with and without LBW for prolonged labor (p = .344) and twin pregnancies (p = .324) when controlling for variables that could interact with the maternal-newborn delivery outcomes. CONCLUSIONS: for Practice Healthcare providers and policy makers need to address the short and long-term effects of LBW throughout the lifecycle in rural Zambia. More maternal-newborn health research is needed to understand the underlying socioeconomic, social, and cultural determinants influencing LBW in rural Zambia.