My Best Alaskan Life: Addressing Adolescent Mental and Reproductive Health in Alaska.

INTRODUCTION: Since 2020, a multisector research team has coordinated a youth-driven, community-based participatory research project to adapt a reproductive life plan for application in a statewide initiative called My Best Alaskan Life (MBAL). The RLP is adapted for Alaskan youth and is intended to support teens in decision-making processes reflecting cultural priorities, personal goals, and sexual and reproductive health. Background. With 46% of youth in Alaska reporting not having used a condom during their last sexual intercourse and 15% not having used contraception, unintended pregnancy and transmission of STIs will continue. Furthermore, Alaskan youth also cite high rates of hopelessness and suicidality, and research shows that poor mental health among adolescents is correlated with developing and maintaining high-risk sexual behaviors. An intervention focusing on supporting mental wellness and developing personal goals in the context of sexual health decision-making may encourage adolescents to adopt safer sexual health behaviors. METHODS: The MBAL research team completed a statewide pilot assessing the design and implementation of the tool, gathering feedback from over 700 survey responses (youth, ages 14-20); conducted 10 in-depth interviews (adult partners at community organizations and clinics); and hosted two youth-led design review sessions. FINDINGS: Questionnaire respondents were overwhelmingly positive about the tool (91% "liked or loved" the tool) and its potential applicability in their community (86% cited "very applicable"). Project next steps include incorporating design recommendations, a statewide randomized control trial and ultimately, open source access for all interested parties.

A qualitative exploration of experiences accessing community and social services among pregnant low-income people of color during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has been associated with increased social and economic stressors among pregnant individuals. While community and social services have been available to mitigate stressors in pregnancy (e.g. food insecurity and financial hardship) and reduce the risk of adverse maternal outcomes, it is unclear how the pandemic impacted access to these resources, particularly in communities of color with lower incomes. OBJECTIVE: To examine the experiences accessing community and social service resources during the COVID-19 pandemic among pregnant people of color with low incomes. DESIGN: Participants for this COVID-related qualitative study were recruited from two sources-a prospective comparative effectiveness study of two models of enhanced prenatal care and the California Black Infant Health Program between August and November of 2020. METHODS: We conducted 62 interviews with Medicaid-eligible participants in California's Central Valley. During their interviews, study participants were asked to share their pregnancy-related experiences, including how they felt the pandemic had affected those experiences. RESULTS: We identified two broad themes: challenges with accessing community and social service resources during the pandemic and opportunities for improving access to these resources. Sub-themes related to challenges experienced included difficulty with remote access, convoluted enrollment processes for community and social services, and problems specific to accessing COVID-19 resources (e.g. testing). Sub-themes related to opportunities to improve access included leveraging instrumental support from perinatal staff and informational (e.g. practical) support from other community programs and pregnant peers. Participant recommendations included leveraging opportunities to improve client experiences through increased transparency and better patient-provider communication. CONCLUSION: This study highlights some important trends that emerged with the rollout of remote service delivery for social services among a vulnerable population. Many participants were able to leverage support through other programs and perinatal staff. These individuals identified additional opportunities to improve client experiences that can inform the future implementation of support services for pregnant people.

Using Community-Based Participatory Research to Design a Patient and Practitioner-Centered Group Prenatal Care Model.

In response to disproportionately high rates of infant mortality and preterm birth among women of color and women in poverty in Fresno County, California, community and academic partners coordinated a community-based participatory research (CBPR) project with local residents. Social isolation and stress, inaccessible prenatal care, and dissatisfaction with care experiences were identified as leading predictors of poor birth outcomes. The PRECEDE-PROCEED framework was used to lead the CBPR effort that resulted in the development of a model of group prenatal care, named Glow! Group Prenatal Care Program (Glow! Program). Group prenatal care (GPNC), which focuses on pregnancy health assessments, education, and peer support, has the potential to address the health and social priorities of women during pregnancy. As a result of the employed CBPR process and the extensive participation from stakeholders, this modified GPNC model responds to the unique needs of the at-risk community members, the agencies aiming to improve maternal-child health experiences and outcomes, and the prenatal care providers offering it to their patients. The methods from this study can be applied in the design and implementation of community-based health care interventions. Returning to community partners throughout the design, implementation, and evaluation phases underscored that health care interventions cannot be designed in silos, and require flexibility to respond to factors that promote improved maternal and infant outcomes, which affect the end goal for the intervention.

Pregnancy-related COVID worry, depressive symptom severity, and mediation through sleep disturbance in a low-income, primarily Latinx population in California's Central valley.

PURPOSE: This study (1) assessed the psychometric properties of a pregnancy-related COVID worry scale, (2) explored variations in pregnancy-related COVID worry over the course of the pandemic, and (3) examined associations between pregnancy-related COVID worry and depressive symptom severity, and evaluated sleep disturbance as a mediator. METHODS: Data were drawn from an ongoing randomized trial comparing the effectiveness of two enhanced forms of prenatal care. The current analysis includes baseline pre-randomization data collected from participants who enrolled November 2020-November 2021 (n = 201). Participants were pregnant individuals with low income and primarily Latinx. RESULTS: Our 7-item scale was valid and reliable for assessing pregnancy-related COVID worry. Pregnancy-related COVID worry did not vary significantly by any participant characteristic or pandemic stage. Pregnancy-related COVID worry was significantly associated with depressive symptom severity in multivariate analysis (p = .002). For each unit increase on the 10-point pregnancy-related COVID worry scale, the odds of mild-to-severe depression increased by 16% (odds ratio = 1.16, 95% confidence interval 1.02-1.32, p = .02), holding all other variables constant. Sleep disturbance mediated the pregnancy-related COVID worry-depressive symptom relationship (48% of the total effect mediated). CONCLUSIONS: Worry about how COVID may impact their baby, birth, and postpartum experiences was associated with higher depressive symptom severity, partly through its effect on sleep. These findings suggest that interventions related to improving sleep quality among perinatal populations may reduce depressive symptoms. TRIAL REGISTRATION: ClinicalTrials.gov NCT04154423, "Engaging Mothers & Babies; Reimagining Antenatal Care for Everyone (EMBRACE) Study".

Perceived stress and COVID-19-related stressors: the moderating role of social support during pregnancy.

Recent evidence on perceived stress during the COVID-19 pandemic shows that birthing people experienced stress from pandemic-related stressors. While psychosocial stress is a significant predictor of adverse birth outcomes, social support can reduce stress levels during pregnancy. This study examined social support moderation of relationships between COVID-19-related stressors and perceived stress during pregnancy. The analysis included data from publicly insured pregnant participants who were enrolled in a randomized control trial of two enhanced prenatal care models in Fresno, California, and completed a third-trimester questionnaire between April and August 2020 (n = 77). Multivariate linear regression was used to estimate the associations between perceived stress and COVID-19-related stressors and social support moderation. COVID-19-related stressors related to childcare and tension at home remained significantly associated with perceived stress adjusting for sociodemographic characteristics and other COVID-19-related stressors. Social support moderated the relationship between perceived stress and loss of childcare (ß = 2.4, 95 percent CI = 0.5-4.3, p = .014). Overall, social support moderated the association between COVID-19 stressors and perceived stress. While social support is commonly conceptualized as protective, the finding of greater stress around childcare among individuals reporting greater social support suggests complexity for leveraging these support networks during the pandemic.

Compounding Effects of Social Vulnerability and Recurring Natural Disasters on Mental and Physical Health.

OBJECTIVE: This study evaluated the relationships between the occurrence of recent and recurring natural disasters on the incidence of acute and chronic health outcomes at the census tract level in 500 cities across the United States between 2001 and 2015. METHODS: Using the Centers for Disease Control and Prevention (CDC) 500 cities data set, the CDC Social Vulnerability Index, and the US Small Business Administration (SBA) Disaster Loan Database, we modeled the incidence of self-reported, poor mental and physical health, or a clinical diagnosis of high blood pressure or asthma in census tracts (N = 27 204 tracts in 500 cities) that had experienced recent or recurring natural disasters while controlling for social and environmental risk factors. RESULTS: Communities that experienced a natural disaster in the previous 5 years compared to those that had not had a higher incidence of poor mental health (RR: 1.02, 95% CI: 1.01-1.02), poor physical health (RR: 1.03, 95% CI: 1.02-1.04), high blood pressure (RR: 1.04, 95% CI: 1.02-1.05), and asthma (RR: 1.01, 95% CI: 1.01-1.02). The incidence of these poor health outcomes increased 1-2% with each additional year that a community experienced a disaster. CONCLUSIONS: Prevention and preparedness plans that work to build resilience in communities before disasters should focus on closing the gap in environmental and social determinants that have been linked with disproportionate health burdens and slow recovery post-disaster.

Pollution, Poverty, and Potentially Preventable Childhood Morbidity in Central California.

OBJECTIVE: To measure ecological relationships between neighborhood pollution burden, poverty, race/ethnicity, and pediatric preventable disease hospitalization rates. STUDY DESIGN: Preventable disease hospitalization rates were obtained from the 2012 California Office of Statewide Health Planning and Development database, for 8 Central Valley counties. US Census Data was used to incorporate zip code level factors including racial diversity and poverty rates. The pollution burden score was calculated by the California Office of Environmental Health Hazard Assessment using 11 indicators. Poisson-based negative binomial regression was used for final analysis. Stratification of sample by age, race/ethnicity, and insurance coverage was also incorporated. RESULTS: Children experiencing potentially preventable hospitalizations are disproportionately low income and under the age of 4 years. With every unit increase in pollution burden, preventable disease hospitalizations rates increase between 21% and 32%, depending on racial and age subgroups. Although living in a poor neighborhood was not associated with potentially avoidable hospitalizations, children enrolled in Medi-Cal who live in neighborhoods with lower pollution burden and lower levels of poverty, face 32% lower risk for ambulatory care sensitive condition hospitalization. Children living in primary care shortage areas are at increased risk of preventable hospitalizations. Preventable disease hospitalizations increase for all subgroups, except white/non-Hispanic children, as neighborhoods became more racially diverse. CONCLUSIONS: Understanding the geographic distribution of disease and impact of individual and community level factors is essential to expanding access to care and preventive resources to improve the health of children in California's most polluted and underserved region.

Contraceptive features preferred by women at high risk of unintended pregnancy.

CONTEXT: Available contraceptives are not meeting many women's needs, as is evident by high levels of typical-use failure, method switching and discontinuation. To improve women's satisfaction with contraceptive methods, determining what features they prefer and how these preferences are satisfied by available methods and methods under development is crucial. METHODS: The importance of 18 contraceptive method features was rated by 574 women seeking abortions--a group at high risk of having unprotected intercourse and unintended pregnancies--at six clinics across the United States in 2010. For each available and potential method, the number of features present was assessed, and the percentage of these that were "extremely important" to women was calculated. RESULTS: The three contraceptive features deemed extremely important by the largest proportions of women were effectiveness (84%), lack of side effects (78%) and affordability (76%). For 91% of women, no method had all of the features they thought were extremely important. The ring and the sponge had the highest percentage of features that women deemed extremely important (67% each). Some streamlined modes of access and new contraceptive technologies have the potential to satisfy women's preferences. For example, an over-the-counter pill would have 71% of extremely important features, and an over-the-counter pericoital pill, 68%; currently available prescription pills have 60%. CONCLUSION: The contraceptive features women want are largely absent from currently available methods. Developing and promoting methods that are more aligned with women's preferences presumably could help increase satisfaction and thereby encourage consistent and effective use.

Five-year follow-up of Peyronie's graft surgery: outcomes and patient satisfaction.

INTRODUCTION: Graft surgery for Peyronie's disease (PD) is associated with significant long-term risks. AIM: To evaluate the clinical and functional outcomes of graft repairs with a minimum of 5-year follow-up. METHODS: A retrospective review of database and third party telephone survey was undertaken in all men who underwent reconstructive graft procedures for PD between May 1999 and May 2005. MAIN OUTCOME MEASURES: Patient demographics, International Index of Erectile Function (IIEF-5) scores, and penile Doppler ultrasonography were performed preoperative. Follow-up assessments included surgical outcomes and overall patient satisfactions. RESULTS: A total of 86 patients with an average age of 54.6 (34 to 73) years underwent Peyronie's graft repair. The average follow-up was 98 (61 to 120) months. Twenty patients received dermal graft whereas 33 patients underwent Tutoplast graft and 33 patients had Stratasis small intestinal submucosa graft. Penile curvature greater than 60 degrees was more common in the Tutoplast and Stratasis groups. Twelve patients used phosphodiesterase type 5 inhibitors or intracavenous agents preoperatively. At the time of review, only 46 (53%) patients were able to be contacted and consented for telephone interview. Although 6 months of postoperative follow-up showed excellent resolution, or significantly less, penile curvature, this figures decreased to 50% in dermal, 87% in Tutoplast, and 76% in Stratasis patients. Further penile length shortening was also reported on patient self-assessment at the recent follow-up. Worsening of IIEF-5 scores were noted with the development of erectile dysfunction was more pronounced in the diabetic cohort (P<0.01). The overall satisfaction on a 5-point scale was 2.6 with more than 65% of patients dissatisfied with the outcomes of the Peyronie's graft surgery. CONCLUSIONS: The recurrence of penile curvature, penile length loss, and the new-onset of ED are not uncommon sequelae and are associated with a significant patient dissatisfaction rate when a 5-year follow-up is achieved.