Firearm suicide risk beliefs and prevention: The role of fear of community violence and firearm ownership for protection.

INTRODUCTION: Household firearm availability is a risk factor for firearm suicide when a household member at-risk for suicide. Firearm ownership for protection and perceptions of community violence may reduce the likelihood of limiting access to firearms as a way to prevent suicide. The association between a firearm suicide risk belief and the intention to reduce firearm access as a means of preventing suicide, with fear of community violence and firearm ownership for protection as moderators, was examined. MATERIALS AND METHODS: The analytic sample consisted of 388 Missouri firearm owners from a cross-sectional, statewide survey of Missouri adults. Logistic regression models were estimated. RESULTS: Among Missouri firearm owners, firearm suicide risk belief was positively associated with the intention of reducing firearm access for firearm owners who were not afraid of community violence and owned a firearm for non-protection reasons (e.g., hunting). DISCUSSION: Findings suggest that firearm suicide prevention efforts must be tailored to address the underlying beliefs about their violence risk among firearm owners who indicate they principally own for protection.

Utilizing a HRSA Training Grant to Promote PMHNP Student Resilience: Answering the Call to Enhance Trauma-Informed Teaching and Learning Practices in Nursing Education.

Nursing burnout has reached a new level of prevalence among professionals and is rising among nursing students and can impact student success in the classroom and clinical areas. Among advanced practice nurses, psychiatric-mental health nurse practitioners have the least favorable combination of low compassion satisfaction and high secondary traumatic stress, placing them at even greater risk for burnout compared to other specialties. Trauma informed teaching and learning principles can serve to prevent burnout and have a positive impact on learning outcomes. Through these teaching methods, nurse educators have the opportunity to both support students during their nursing education and prepare students for the professional stressors that contribute to burnout. This quality improvement project involved implementation and evaluation of a HRSA funded program to train PMHNP students interested in working in rural and underserved areas. The training intervention included didactic curricular enhancements, a trauma resiliency training and a longitudinal clinical practicum. Qualitative program outcomes indicated that trainees were implementing trauma-informed principles and skills with patients and for self-care during their nursing training and at one year follow-up. The program may offer practical upstream solutions for nurse educators and future studies should explore concepts more formally to develop best practice models.

Perceptions of abortion access across the United States prior to the Dobbs v. Jackson Women's Health Organization decision: Results from a national survey.

CONTEXT: Abortion is common in the United States (US), although access is becoming more difficult for some. In addition to restrictive policies that ban most abortion, limit the number of providers and increase costs, barriers to access also include less supportive cultural climates and stigma related to abortion. Prior to the Dobbs v. Jackson Women's Health decision of the United States Supreme Court, research suggested that people generally believed it was easy to access abortion, but this research did not examine the underlying factors that drive these perceptions. METHODS: In 2019, using data from closed and open-ended survey questions, we examined differences in people's assessment of abortion access within the state they reside and factors that influence those perceptions. We recruited English- and Spanish-speaking US adults (N = 2599) from Qualtrics' national panel using quota-based sampling to participate in a web-based survey. We used multinomial logistic regression to examine predictors of access perceptions across demographic characteristics and thematic analysis to analyze open-ended responses. RESULTS: Fifty-three percent of participants believed abortion was easy to access in their state. Spanish speakers and participants from legislatively "hostile" states were more likely to perceive access as difficult. Legality-related knowledge and pro-life identity were associated with perceiving abortion access as easy. CONCLUSIONS: Prior to Dobbs, participants' interpretation of the ease or difficulty of accessing abortion were subjective. Misconceptions about state abortion laws and the prevalence of providers were common, suggesting a need for more education about abortion laws, policies, and access.

"It's a walk of shame": Experiences of unintended pregnancy and abortion among sexual- and gender-minoritized females in urban India.

Background: Unintended pregnancy and safe abortion access in India remain critical public health concerns. The health of sexual- and gender-minoritized females (SGMF; those assigned female at birth and identify as other than heterosexual and/or as other than cisgender women) in India is understudied. Aim: We examined experiences of unintended pregnancy and abortion among SGMF individuals in urban India. Methods: We used focus group discussions (n = 8 individuals in two groups) and interviews (n = 20) with SGMF individuals. Data were collected in December 2017. Transcripts were analyzed using a priori thematic analysis and then open thematic analysis in Dedoose online software. Results: Nine participants experienced or suspected they had unintended pregnancies. Pregnancy circumstances were mostly due to sex without using a barrier method. Participants discussed using traditional methods to induce abortion or changing their approach to contraception. Social support was often lacking, though partners were supportive of abortion choices. Participants reported stigma and surveillance from family, friends, providers, and community members. Conclusion: These findings highlight the effects of stigma in relation to abortion and unintended pregnancy on health and relationships.

Definitions of sex and intimacy among gender and sexual minoritised groups in urban India.

Understandings of sex and intimacy carry important implications for individuals' behaviours and health. In many research studies, sex is narrowly defined as penile-vaginal intercourse, which may exclude the experiences of sexual and gender minoritised individuals. Likewise, sexual intimacy, or intimacy related to sexual experience between two or more people, is under-researched. Even less is known about how sexual and gender minoritised individuals in countries such as India understand these concepts. This qualitative study included focus group discussions and interviews conducted in three urban areas in India - Chennai, Bangalore and Kolkata. Data were analysed thematically. Participants described sex as a context-dependent experience, acknowledging that their definitions might not capture others' characterisations. Participants reported numerous barriers to intimacy, especially for transgender and other gender minority individuals. We discuss the implications of simplistic definitions related to gender and sexuality for future sexuality research and public health in settings such as those discussed here.

"Sex" and the Ace Spectrum: Definitions of Sex, Behavioral Histories, and Future Interest for Individuals Who Identify as Asexual, Graysexual, or Demisexual.

This paper explores how people (n = 1,093) who identify as asexual or on the ace spectrum (i.e., graysexual, demisexual) define sex behaviorally using a list of 22 specific behaviors and assesses their lifetime behavioral histories and interest in future engagement in these activities. Lifetime behavioral history was also compared to each individual's personal definition of sex. Asexual, demisexual, and graysexual groups defined sex similarly. Although there were significant group differences in behavioral histories, almost all had engaged in behaviors included in their personal definition of sex. There was little interest in engaging in "sex" in the future (~4% asexual and graysexual groups, ~12% demisexuals, p < .004). Reasons for or against engaging in these behaviors in the future were explored qualitatively. The most common reasons were classified as "Emotional connection," "Partner interest," and "Disinterest-Disgust," with significant group differences noted. Disinterest-Disgust was the most frequently cited reason for the asexual group (43%). Emotional Connection was the most frequent reason for the graysexual (40%) and demisexual (69.3%) groups. Findings highlight the heterogeneity of the ace community with regard to history of and interest in sexual behaviors and the importance of distinguishing between wanting and being willing to engage in sexual behaviors across the ace spectrum.

Family Formation Goals Among Sexual and Gender Minority Individuals in Urban India.

Sexual and Gender Minority (SGM) individuals' (nonheterosexual or noncisgender) desires and intentions to form families have been under-researched. Further, research on family formation among SGM individuals is even more scant in India. Family formation, a significant milestone for many individuals, has important implications for overall health. Using data from interviews (n=25) and focus group discussions (8 participants) with SGM individuals in Bangalore, Chennai, and Kolkata, we explore desires and intentions related to parenting. Pressure to have children was ubiquitous, though participants' parenting-related desires varied. Participants considering parenting noted many priorities including their financial stability, relationships with partners, and the legality and legitimacy of their partnerships. Adoption and assisted biological reproduction (e.g., IVF) were the preferred methods of family formation. Experiences and expectations of stigma for themselves and their children shaped participants' limited control over parenting-related decisions. However, they exerted agency as they navigated achieving their ideals for family formation.

Existence, Distribution, and Characteristics of STD Clinics in the United States, 2017.

OBJECTIVES: Studies of sexually transmitted disease (STD) clinics have been limited by the lack of a national list for representative sampling. We sought to establish the number, type, and distribution of STD clinics and describe selected community characteristics associated with them. METHODS: We conducted a 2-phased, multilevel, online search from September 2014 through March 2015 and from May through October 2017 to identify STD clinics in all 50 US states and the District of Columbia. We obtained data on clinic name, address, contact information, and 340B funding status (which requires manufacturers to provide outpatient drugs at reduced prices). We classified clinics by type. We also obtained secondary county-level data to compare rates of chlamydia and HIV, teen births, uninsurance and unemployment, and high school graduation; ratios of primary care physician to population; health care costs; median household income; and percentage of population living in rural areas vs nonrural areas. We used t tests to examine mean differences in characteristics between counties with and without STD clinics. RESULTS: We found 4079 STD clinics and classified them into 10 types; 2530 (62.0%) clinics were affiliated with a local health department. Of 3129 counties, 1098 (35.1%) did not have an STD clinic. Twelve states had an STD clinic in every county, and 34 states had ≥1 clinic per 100 000 population. Most STD clinics were located in areas of high chlamydia morbidity and where other surrogate needs were greatest; rural areas were underserved by STD clinics. CONCLUSIONS: This list may aid in more comprehensive national studies of clinic services, STD clinic adaptation to external policy changes (eg, in public financing or patient access policy), and long-term clinic survival, with special attention to clinic coverage in rural areas.

Paths to Parenthood Among Self-Identified Bisexual Individuals in the United States.

Bisexual parents have been notably absent from prior research on parenting, despite comprising the largest proportion of parents among "lesbian, gay, and bisexual" (LGB) individuals. Indeed, recent national probability data indicate that young bisexual women are more likely than their heterosexual counterparts to report having at least one child. Intentions to have children, patterns of family planning and contraception use, and related issues have important implications for health and healthcare-related decisions and priorities among bisexual parents. We conducted in-depth interviews with a sample of 33 bisexual parents from across the U.S. who reported having at least one child (genetic, adopted, step or foster child, guardian, and/or warden of the state). In cases of intentional pregnancies, participants considered relationship and financial stability, job security and their ideal family size. Unintentional pregnancies, as well as pregnancy terminations, were often reframed as positive experiences. After deciding not to have more children, participants reported using contraceptive methods, including sterilization or long-acting reversible contraceptive methods (e.g., intrauterine devices). Instances of deception, in which partners deceived participants with false beliefs regarding their contraceptive use, were recalled negatively for the relatively small number of participants who reported such experiences. Overall, our findings point to a diversity in the intentions and ways bisexual individuals become parents, similar to parents of other sexual identities. Acknowledgements of the diverse experiences and concerns faced by bisexual parents may be beneficial in improving efforts related to providing appropriate and relevant health- and healthcare-related services.

SCN11A Arg225Cys mutation causes nociceptive pain without detectable peripheral nerve pathology.

OBJECTIVE: The SCN11A gene encodes the NaV1.9 sodium channel found exclusively in peripheral nociceptive neurons. METHODS: All enrolled participants were evaluated clinically by electrophysiologic studies, DNA sequencing, and punch skin biopsies. RESULTS: All affected family members are afflicted by episodes of pain. Pain was predominantly nociceptive, but not neuropathic in nature, which led a diagnosis of fibromyalgia in some patients. All patients had normal findings in nerve conduction studies for detecting large nerve fiber neuropathies and skin biopsies for detecting small nerve fiber pathology. CONCLUSIONS: Unlike those patients with missense mutations in SCN11A, small fiber sensory neuropathy, and neuropathic pain, the Arg225Cys SCN11A in the present study causes predominantly nociceptive pain with minimal features of neuropathic pain and undetectable pathophysiologic changes of peripheral neuropathy. This finding is consistent with dysfunction of nociceptive neurons. In addition, since nociceptive pain in patients has led to the diagnosis of fibromyalgia, this justifies a future search of mutations of SCN11A in patients with additional pain phenotypes such as fibromyalgia to expand the clinical spectrum beyond painful small fiber sensory neuropathy.

Exploring Provider Perspectives as Barriers and Facilitators to Implementation of Quality Family Planning Recommendations at Title X Clinics: A Qualitative Study.

BACKGROUND: In 2014, the Centers for Disease Control and Prevention and the Office of Population Affairs released a document entitled Providing Quality Family Planning Services (QFP), which outlined recommendations for delivery of family planning services using a client-centered approach. These aimed to standardize service provision and address numerous reproductive health challenges. To date, little is known about QFP implementation or the factors influencing its adoption by clinicians. STUDY DESIGN: Semistructured interviews were conducted with 16 family planning providers at Title X-funded clinics in Indiana and Missouri to measure provider attitudes toward the QFP, their influence on adoption of the recommendations, and other barriers to QFP implementation. Interviews were transcribed verbatim and analyzed in Nvivo. Using the diffusion of innovation theory as a framework, we identify themes related to innovation adoption. RESULTS: Findings suggest that a provider's values related to client-centered counseling and views regarding the relative advantage of the QFP are key factors influencing adoption. Participants identified a number of structural and interpersonal barriers to implementation including misinterpretation of the QFP and billing issues. CONCLUSIONS: Although participants expressed that QFP was an improvement over previous guidelines, misalignment of the recommendations with professional values and experiences, lack of clarity of the guidelines, and logistical issues serve as major barriers to adoption and implementation. These findings inform our understanding of policy adoption. Increased training and precise messaging is necessary to improve adoption of QFP at Title X clinics.

Teaching a Systems Approach: An Innovative Quality Improvement Project.

BACKGROUND: Nurse practitioners are required to navigate complex health care systems. Quality improvement (QI) projects provide the opportunity for nurse practitioner students to learn systems knowledge and improve health care outcomes in patient populations. A gap in the literature exists around how to systematically teach, apply, and measure QI curricular objectives at the master's level. METHOD: Six faculty evaluated the QI project for the psychiatric nurse practitioner master's program by identifying the most challenging QI concepts for students to apply, revising their teaching strategies to address gaps, and retrospectively evaluating the outcomes of these curriculum changes by comparing student outcomes before and after the curricular changes. RESULTS: A significant difference was noted on QI project performance between students in the 2014 and 2015 graduating classes, measured by the scores earned on students' final papers (t[92] = 1.66, p = .05, d = .34, r(2) = .0289). CONCLUSION: Theoretical principles of adult and cooperative learning were used to inform curricular changes to enhance student's acquisition of QI skills.

Quantifying environmental DNA signals for aquatic invasive species across multiple detection platforms.

The use of molecular surveillance techniques has become popular among aquatic researchers and managers due to the improved sensitivity and efficiency compared to traditional sampling methods. Rapid expansion in the use of environmental DNA (eDNA), paired with the advancement of molecular technologies, has resulted in new detection platforms and techniques. In this study we present a comparison of three eDNA surveillance platforms: traditional polymerase chain reaction (PCR), quantitative PCR (qPCR), and digital droplet PCR (ddPCR) in which water samples were collected over a 24 h time period from mesocosm experiments containing a population gradient of invasive species densities. All platforms reliably detected the presence of DNA, even at low target organism densities within the first hour. The two quantitative platforms (qPCR and ddPCR) produced similar estimates of DNA concentrations. The analyses completed with ddPCR was faster from sample collection through analyses and cost approximately half the expenditure of qPCR. Although a new platform for eDNA surveillance of aquatic species, ddPCR was consistent with more commonly used qPCR and a cost-effective means of estimating DNA concentrations. Use of ddPCR by researchers and managers should be considered in future eDNA surveillance applications.

Physical attractiveness and sex in judgments about perceived sexually promiscuous others.

This study investigated sex and physical attractiveness in evaluations of perceived promiscuous persons. Evidence for the double standard was expected, such that men would rate a promiscuous woman less favorably than women would rate a promiscuous man. University students (25 women and 24 men) viewed a photograph of an attractive or unattractive target and read fictitious information, including promiscuous sexual behavior, about the target. Analysis gave physical attractiveness effects and limited evidence for a reverse double standard. Women rated a promiscuous man more negatively than men rated a promiscuous woman.