How Engineers and Roadside Vegetation Managers Maintain Roadside Vegetation in Iowa, USA.

Recently the value of roadside vegetation as habitat for pollinators has gained increased attention, particularly in areas dominated by agriculture where there is little native vegetation available. However, many factors, including safety, cost, public perception, erosion control, and weedy plants must be considered when managing roadside vegetation. Although their decisions influence thousands of hectares of public rights-of-way, how engineers and roadside managers maintain roadside vegetation has been the subject of little research. In this study, we surveyed county engineers and roadside managers who manage vegetation along secondary roads in Iowa, USA to assess how they maintain roadside vegetation. Some counties employ roadside managers, who often have an environmental sciences background, to implement the on-the-ground management of roadside vegetation, while some counties use other staff. Compared to engineers, roadside managers more strongly agreed that using the ecological principles of integrated roadside vegetation management (IRVM) provided environmental benefits. Engineers in counties with a roadside manager more strongly agreed that IRVM practices reduce the spread of invasive species and provide attractive roadsides. Both engineers and roadside managers mentioned challenges to managing roadside vegetation, including interference with some native plantings by adjacent landowners, and ranked safety and soil erosion concerns as the highest priorities when making decisions. Four in ten roadside managers said their counties had protected native plant community remnants on secondary roadsides. Our findings can inform conservation outreach efforts to those responsible for managing roadside vegetation, and emphasize the importance of addressing safety and soil erosion concerns in roadside research and communications.

Local Decision-makers' Perspectives on Roadside Revegetation and Management in Iowa, USA.

Environmental practitioners must understand those they collaborate with to implement programs that are both socially and ecologically effective. Practitioners who understand decision-makers' perspectives are better able to collaborate to lower political, financial, and cultural obstacles. In this study, we surveyed decision-makers involved with a voluntary environmental program in Iowa, USA. Iowa counties can choose to manage their roadside vegetation using an ecological approach, called integrated roadside vegetation management. Key decision-makers who decide whether a county has a roadside program are the county board of supervisors and the county conservation board. We used a mixed-mode design to survey the conservation board directors and chairs of the board of supervisors in each county. Our main goals were to understand the decision-makers' perceived benefits and barriers to having a roadside program in their counties, as well as the key factors influencing their decisions about roadside vegetation management. Safety, maintenance cost savings, and erosion control were the main factors that influenced decision-making, while pollinators and other wildlife received the least consideration. However, decision-makers in counties with a roadside vegetation manager were more influenced by pollinators and other wildlife compared to their counterparts in counties without a roadside vegetation manager. The main barriers to having a program include a lack of resources or other concerns being a higher priority. Emphasizing safety, cost savings, and erosion control benefits of roadside programs, and identifying ways to lower startup costs may increase buy-in with county decision-makers.

Lessons from the field: A mixed methods analysis of hair stylists' reflections on their experience as lay health educators.

Beauty salons are unique settings to provide community-based health education. The Speak UP! Salon Project trained hair stylists to deliver health messages related to reducing unintended pregnancy to female clients in the 18-30-year age range. The project ran from 2009 through 2011. Midway through the project, we held focus groups with stylists and administered a questionnaire as concurrent process evaluation measures. Forty-seven of the ninety-three stylists then active in the project attended one of eleven focus groups. The focus groups included questions about stylists' experiences and their reflections on their role as lay health educators. Using Krueger's qualitative methodology, we systematically analyzed the focus group transcripts. Six themes emerged from the focus groups, including stylists' ability to deliver lay health education, increased comfort levels, stylists' self-monitoring, support materials, messaging outside the target audience, and intangible benefits to the stylists. The questionnaire included twenty-six items and provided quantitative support for identified themes. Findings indicated that stylists were a strong and willing community partner for delivering health education, they received substantial positive feedback from clients, and their efforts reached individuals far beyond the target audience; however, professional health educators must provide substantial training and support to ensure the program's success.

The Speak UP! Salon Project: Using Hair Stylists as Lay Health Educators About Unintended Pregnancy.

The Speak UP! Salon Project trained 126 hair stylists from 60 salons as lay health educators to increase knowledge about contraceptives and inform clients about financial support for long-acting reversible contraceptives at local family planning clinics. Stylists' informal social support system, combined with the rapport built with clients over time, make them excellent candidates for lay health educator projects. This 3-year salon-based intervention was implemented in nine counties in a Midwestern state. Results from a subsample of participants who completed an online questionnaire (n = 177) indicate that hair stylists are a feasible method to link target populations to health information and to the health care system. The benefits and challenges of collecting data in a salon environment are also discussed.

"Baby? Baby Not?": Exploring Women's Narratives About Ambivalence Towards an Unintended Pregnancy.

Unintended pregnancy among adult women is a significant public health challenge in the United States. Research has identified ambivalence as a risk factor for not using contraceptives. The qualitative study presented here examined women's narratives about ambivalence toward unintended pregnancy. In-depth interviews were conducted in 2012 with 28 women aged 20-45 years old who were recruited primarily via flyers in family planning clinics in a rural, Midwestern state. The interviews were coded for salient themes. Almost 40 percent of the women said that they had experienced an unintended pregnancy. All but two women expressed ambivalence, stating that they had both good and bad feelings about getting pregnant unintentionally. Women expressed if a pregnancy did occur, they would just have to step up and "deal with it." They recognized a baby was something special but not without negative aspects. Those who were less ambivalent (and more negative) had compelling reasons why, but even those women expressed some positive feelings. At times, ambivalence was expressed by negative reactions about having a child that coincided with believing that becoming a parent or having another child would have a positive impact on themselves. This study provides an examination of women's narratives about ambivalence toward pregnancy. Overall, women's narratives constructed ambivalence as arising from both positive and negative emotions, as well as beliefs about costs and benefits, associated with unintended pregnancy. Given its association with a lack of contraceptive use, understanding the components of ambivalence (e.g., feelings, beliefs) is important to bolstering interventions aimed toward decreasing ambivalence and increasing contraceptive use.

Impact of a passive social marketing intervention in community pharmacies on oral contraceptive and condom sales: a quasi-experimental study.

BACKGROUND: Almost 50% of pregnancies in the United States are unwanted or mistimed. Notably, just over one-half of unintended pregnancies occurred when birth control was being used, suggesting inappropriate or poor use or contraceptive failure. About two-thirds of all women who are of reproductive age use contraceptives, and oral hormonal contraceptives remain the most common contraceptive method. Often, contraceptive products are obtained in community pharmacies. The purpose of this study was to determine whether a pharmacy-based intervention would impact sales of contraceptive products in pharmacies. METHODS: This study was conducted in Iowa and used a quasi-experimental design including 55 community pharmacies (independent and grocery) in 12 counties as the intervention and 32 grocery pharmacies in 10 counties as a comparison group. The passive intervention was focused towards 18-30 year old women who visited community pharmacies and prompted those of childbearing age to "plan your pregnancy" and "consider using birth control". The intervention was delivered via educational tri-fold brochures, posters and 'shelf talkers.' Data sources for evaluation were contraceptive sales from intervention and comparison pharmacies, and a mixed negative binomial regression was used with study group*time interactions to examine the impact of the intervention on oral contraceptive and condom sales. Data from 2009 were considered baseline sales. RESULTS: From 2009 to 2011, condom sales decreased over time and oral contraceptives sales showed no change. Overall, the units sold were significantly higher in grocery pharmacies than in independent pharmacies for both contraceptive types. In the negative binomial regression for condoms, there was an overall significant interaction between the study group and time variables (p = 0.003), indicating an effect of the intervention, and there was a significant slowing in the drop of sales at time 3 in comparison with time 1 (p < 0.001). There was a statistically significant association between pharmacy type and study group, where the independent intervention pharmacies had a higher proportion of stores with increases in condom sales compared to grocery pharmacies in the intervention or comparison group. CONCLUSIONS: A passive community pharmacy-based public health intervention appeared to reduce the decrease in condom sales from baseline, particularly in independent pharmacies, but it did not impact oral contraceptive sales.

It isn't all about language: communication barriers for Latinas using contraceptives.

PURPOSE: Little is known about barriers that Latinas in the United States face in preventing unintended pregnancies beyond those of language and cost. This study examined factors inhibiting contraceptive use among 18- to 30-year-old Latinas in the Midwest. METHOD: Individual interviews (N = 31) were conducted in Spanish with Latinas residing across the state. The interview protocol included questions about contraceptives and unintended pregnancies. Interviews were recorded, transcribed, translated, and coded for themes related to barriers. RESULTS: The majority of the barriers were related to communication but not English proficiency. Respondents talked about specific situations and experiences in which communication presented obstacles to using contraceptives. DISCUSSION: While language and cost are important barriers, attention needs to be paid to the other communication issues that women face related to culture, religion, partners, family, and spontaneity. IMPLICATIONS: Health care providers need to address the range of communication barriers that affect Latinas' contraceptive use.

Prevalence of problem gambling in Iowa: revisiting Shaffer's adaptation hypothesis.

BACKGROUND: Pathological gambling (PG) is an important public health problem. We assessed the prevalence of PG and problem (at-risk) gambling in a random sample of Iowa adults and compared the results to survey data collected in 1989 and 1995. The goal of this study was to examine whether continued expansion of gambling venues is associated with increased rates of problematic gambling behavior. METHODS: A random digit dialing telephone screening was conducted in eastern Iowa of men and women age ≥18. Respondents were administered the South Oaks Gambling Screen (SOGS) to assess lifetime gambling behavior. Demographic and clinical variables were collected. RESULTS: A total of 356 respondents (147 men, 209 women) completed the SOGS, and all reported lifetime gambling participation. PG (SOGS ≥5) was found in 5 (1.4%) and problem gambling (SOGS = 3, 4) in 8 (2.2%) respondents. Disordered gambling (SOGS ≥3) was found in 13 (3.6%) respondents. Risk factors for disordered gambling included age (odds ratio [OR] = 0.64 per 10-year age increase), income (OR = 0.82 per $10,000 increase), minority group status (OR = 5.75), number of lifetime gambling activities (OR = 1.27), and having ever gambled ≥$100 (OR = 13.3). Overall gambling participation was significantly less in the current sample, compared with data collected in 1995. CONCLUSIONS: Recent gambling participation was less than in 1995, despite the continued expansion of gaming opportunities. Disordered gambling was associated with younger age, lower income, and minority group status. The results are consistent with Shaffer's "adaptation" hypothesis, which posits that following an initial increase in gambling participation, problematic gambling stabilizes at a lower level.

Ambivalence, communication and past use: understanding what influences women's intentions to use contraceptives.

Unintended pregnancy among women in the 18-30 age group is a public health concern. The Extended Parallel Process Model (EPPM) provides a framework for exploring how women's perceptions of threat, efficacy, and fear influence intentions to use contraceptives. Past use and communication with best friends and partners were also considered. A telephone survey of 18-30-year-old women (N = 599) was completed. After univariate and bivariate analyses were conducted, the variables were entered into a hierarchal, multi-variate linear regression with three steps consistent with the EPPM to predict behavioral intention. The first step included the demographic variables of relationship status and income. The constructs for the EPPM were entered into step 2. Step 3 contained the fear measure. The model for the third step was significant, F(10,471) = 36.40, p < 0.001 and the variance explained by this complete model was 0.42. Results suggest that perceived severity of the consequences of an unintended pregnancy (p < 0.01), communication with friends (p < 0.01) and last sexual partner (p < 0.05), relationship status (p < 0.01), and past use (p < 0.001) were associated with women's intentions to use contraceptives. A woman's perception of the severity was related to her intention to use contraceptives. Half of the women (50.3%) reported ambivalence about the severity of an unintended pregnancy. In our study, talking with their last sexual partner had a positive effect on intentions to use contraceptives, while talking with friends influenced intentions in a negative direction. These results reconfirm the need for public health practitioners and health care providers to consider level of ambivalence toward unintended pregnancy, communication with partner, and relationship status when trying to improve women's contraceptive behaviors. Implications for effective communication interventions are discussed.

Unlocking the condoms: the effect on sales and theft / Liberando los condones: el efecto en ventas y robos

Community pharmacies may place condoms in locked displays or behind glass, thereby reducing access and consequent use. Objective: Quantify sales and theft of condoms when condoms were unlocked and removed from behind glass in grocery pharmacies Methods: Design. In this pilot study, condom displays were unlocked in selected pharmacies for three months. Participants. Eight grocery pharmacies in central Iowa agreed to participate. Intervention. Stores provided inventory at baseline, sales/theft thereafter in three monthly reports and sales for the same period one-year earlier. Outcome measures. Descriptive statistics quantified condom theft and sales. Number of pharmacies leaving condoms unlocked after the intervention was determined. Results: Theft varied by pharmacy and ranged from an average of 1.33 boxes (units) per month to 27.33 per month. All stores experienced some increase in sales during the intervention. Two locations decided to re-lock their displays, only one indicated theft as the reason. Conclusion: After removing condoms from locked displays, more condoms were purchased and stolen from the study pharmacies. Sales outweighed theft in all pharmacies (AU)

Las farmacias comunitarias pueden situar los condones en estanterías cerradas o detrás de un cristal, reduciendo así el acceso y consiguientemente el uso. Objetivo: Cuantificar las ventas y el robo de condones cuando están libres y retirados de detrás de un cristal en las farmacias. Métodos: Diseño. En este estudio piloto, se abrieron las estanterías de los condones en unas farmacias seleccionadas durante tres meses. Participantes. Ocho farmacias en el centro de Iowa aceptaron participar. Intervención. Las farmacias proporcionaron el inventario al principio, informes de las ventas/robos en los tres meses posteriores y las ventas para ese mismo periodo de un año antes. Medidas de resultados. La estadística descriptiva cuantificó las ventas y robos de condones. Se determinó el número de farmacias que dejaron los condones abiertos después de la intervención. Resultados: Los robos variaron por farmacia y oscilaron entre una media de 1,33 cajas (unidades) por mes a 27,33 por mes. Todas las farmacias experimentaron algún aumento en las ventas durante la intervención. Dos establecimientos decidieron volver a cerrar los expositores de condones, y sólo uno indicó el robo como causa. Conclusión: Después de retirar los condones de los expositores cerrados, se vendieron y robaron más condones en las farmacias estudiadas. Las ventas sobrepasaron los robos en todas las farmacias (AU)

Unlocking the condoms: The effect on sales and theft.

UNLABELLED: Community pharmacies may place condoms in locked displays or behind glass, thereby reducing access and consequent use. OBJECTIVE: Quantify sales and theft of condoms when condoms were unlocked and removed from behind glass in grocery pharmacies. METHODS: Design. In this pilot study, condom displays were unlocked in selected pharmacies for three months. Participants. Eight grocery pharmacies in central Iowa agreed to participate. Intervention. Stores provided inventory at baseline, sales/theft thereafter in three monthly reports and sales for the same period one-year earlier. Outcome measures. Descriptive statistics quantified condom theft and sales. Number of pharmacies leaving condoms unlocked after the intervention was determined. RESULTS: Theft varied by pharmacy and ranged from an average of 1.33 boxes (units) per month to 27.33 per month. All stores experienced some increase in sales during the intervention. Two locations decided to re-lock their displays, only one indicated theft as the reason. CONCLUSION: After removing condoms from locked displays, more condoms were purchased and stolen from the study pharmacies. Sales outweighed theft in all pharmacies.

Young women's knowledge, attitudes, and behaviors related to long-acting reversible contraceptives.

BACKGROUND: The present study explored 18- to 30-year-old women's knowledge and perceptions of the long-acting, reversible contraceptives (LARCs) Mirena and Implanon in a Midwestern state in the United States. METHODS: A telephone survey (n = 543) and 18 focus groups (n = 106) were conducted with women across a rural, Midwestern state. During the telephone survey, women answered questions related to their awareness and knowledge of two LARCs. During the focus groups, participants were asked to respond to questions related to their awareness, knowledge, behaviors, and perceptions of LARCs. RESULTS: In the telephone survey, half of the women reported hearing of Mirena. Only 8.0% of women had heard of Implanon. In the focus groups, most women reported knowing little about LARCs. Benefits associated with other contraceptives were not associated with LARCs. Women were concerned about potential side effects and problems stemming from using a contraceptive that is new to them. CONCLUSION: Increased use of LARCs would likely reduce the unintended pregnancy rate. As described, although some young women are aware of these long-term contraceptive options, there is still a need to educate women on their availability, use, and potential benefit.

Preventing unintended pregnancies and improving contraceptive use among young adult women in a rural, Midwestern state: health promotion implications.

Despite high rates of unintended pregnancy among women aged 18 to 30 years, little research has been conducted to understand the factors associated with their contraceptive use. Eighteen focus groups were conducted with young adult women (N = 106) who were mostly white, non-Hispanic. Results suggested that contraceptive use was negatively affected by low contraceptive knowledge; use of alcohol; a lack of planning for sex; a misperception of the likelihood of pregnancy; forgetting to use contraceptives; and concerns about side effects, cost, and confidentiality. Women liked the peace of mind that using contraceptives gave them and the benefits of regular periods from some hormonal methods. Implications for reducing unintended pregnancies through interventions are offered.

The green acres effect: the need for a new colorectal cancer screening campaign tailored to rural audiences.

National health communication campaign developers have ignored rural audiences in campaign development and testing, despite the health disparities that exist for this group. Researchers in a rural Midwestern state tested the appropriateness of CDC's national colorectal cancer screening campaign, Screen for Life. Based on focus groups and a quasiexperimental design evaluation, researchers determined that the national campaign did not adequately address the needs of the rural audience. A new print and radio campaign was developed based on previous findings, grounded in social marketing and the health belief model. New tailored campaign materials were refined in focus groups. Final versions were tested in two quasiexperimental designs. Results support the campaign's reach and efficacy. Those in the intervention county were significantly more likely than the unexposed to (a) report recent exposure to ads, (b) plan to seek out information regarding screening, and (c) plan to get screened in the near future.

Prenatal office practices regarding infant feeding choices.

The objective of this study was to determine the obstetric care providers' roles in breast-feeding promotion during prenatal care. A questionnaire addressing breast-feeding issues was sent to family practitioners (FP), obstetric-gynecologists (OB/GYN), and nurse midwives (NM) in Iowa, USA. All NM, 97% of FP, and 85% of OB/GYN reported asking infant feeding preference-usually only at the first prenatal visit. NM (73%) were most likely to provide extensive breast-feeding counseling. OB/GYN (68%) and FP physicians (90%) reported doing their own breast-feeding counseling. Breast examinations targeting future breast-feeding problems were done in 82% to 84% of patients. NM practices shared more information supportive of breast-feeding. Nearly all providers offered prenatal classes, but only 41% of FP offered breast-feeding classes. Free formula samples were available in 73% of FP, 54% of OB/GYN, and 36% NM offices. Pamphlets on formula feeding and also breast-feeding were readily available. Overall NM (64%) reported being strong breast-feeding advocates compared to only 13% of FP and 7% of OB/GYN. In conclusion, little promotion of breast-feeding occurs in most prenatal practice settings.

Across the fertility lifespan: desire for pregnancy at conception.

PURPOSE: To illustrate trends in unintended pregnancy over a 5-year period and to describe variations in desire for pregnancy at conception in relation to maternal age, race/ethnicity, income, and education. STUDY DESIGN AND METHODS: Data were collected as part of the Iowa Barriers to Prenatal Care Project, a large, multiyear study of new mothers. A brief questionnaire eliciting maternal experiences and behaviors during pregnancy was administered to new mothers in all Iowa hospitals providing maternity care following the birth of their baby. Sample sizes ranged from 16,714 to 19,421 over the 5 years included in this analysis (1997 to 2001), and response rates ranged from 44% to 53%. RESULTS: The study sample closely matched the overall statewide profile of women in this age group. In each of the 5 years, about one third of the mothers giving birth indicated that they did not intend to become pregnant at that time, and another 4% to 5% indicated that they did not want to be pregnant at that time or in the future. There were no substantive variations across years. Maternal age, race/ethnicity, income, and education were significantly related to intendedness of pregnancy. CLINICAL IMPLICATIONS: The findings underscore the continuing challenge of unintended pregnancy, despite recent national attention to this issue. All women of childbearing age should be considered at risk for unintended pregnancy. Additional work is needed to examine reasons, attitudes, and behaviors associated with unintended pregnancies and to determine the relative predictive strength of key demographic variables to improve interventions aimed at decreasing unintended pregnancy rates.