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Background: Guidelines recommend timely follow-up with a cardiology specialist for patients hospitalized with heart failure (HF), but it is unknown whether the timeliness of specialty cardiovascular care post-discharge correlates with clinical risk., Objective: Assess the association between estimated mortality risk and post-HF hospitalization cardiology follow-up., Methods: In a cohort of Veterans hospitalized with HF in acute care VA hospitals between 1/1/2018 and 9/15/2022, we estimated the association of mortality risk at discharge with post-discharge cardiology encounters via logistic regression. We also evaluated the association between cardiology visits and sociodemographic and clinical characteristics, and described variability in post-discharge follow-up rates across VA facilities., Results: We identified a cohort of 84,348 Veterans hospitalized with HF with 120,619 hospital admissions. Of a sub-cohort of 57,554 Veterans with 79,866 hospitalizations surviving at least one year after discharge, 32.1% of hospitalizations were followed by a cardiology visit within two weeks, and 49.3% within one month. Marginal probabilities of two-week and one-month follow-up were higher for hospitalizations in the highest-risk quintile than those in the lowest-risk quintile (34% vs. 30% and 51% vs. 47%, respectively; p<0.001 for both intervals). In a time-to-event model in the full cohort, there was a slightly negative association between risk and likelihood of one-month follow-up (coefficient for MAGGIC score = -0.004, 95% confidence interval [CI] -0.005 - -0.003). Black Veterans were less likely to have either two-week or one-month follow-up (adjusted odds ratios 0.93 [95% confidence interval [CI] 0.90-0.97] for two weeks and 0.93 [95% CI 0.89-0.96] for one month). Female Veterans were also less likely to have follow-up within one month of hospital discharge (adjusted odds ratio 0.90 [95% CI 0.90-0.98]). Conversely, patients with a primary versus secondary hospital diagnosis of HF and those with reduced versus preserved ejection fraction were more likely to have two-week follow-up (adjusted odds ratios 1.67 [95% CI 1.62-1.73] and 1.72 [95% CI 1.67-1.78], respectively) and one-month follow-up (adjusted odds ratios 1.83 [95% CI 1.78-1.88] and 1.85 [95% CI 1.80-1.90], respectively). One-month follow-up rates varied from 5% to 69% across VA facilities., Conclusions: The rate of visits with a cardiologist within two weeks or one month following HF hospitalization was low overall, was at most modestly associated with estimated mortality risk at discharge, and varied by sex, race/ethnicity, and across VA facilities. Increasing visit rate after HF hospitalization should be evaluated as a mechanism to improve outcomes after HF hospitalizations, particularly for higher-risk individuals., (Copyright © 2025. Published by Elsevier Inc.)

Competing Interests: Funding Support and Author Disclosures Dr Sandhu is supported by National Heart, Lung, and Blood Institute grant 1K23HL151672. Dr Rodriguez was funded by NIH National Heart, Lung, and Blood Institute grants 1K01HL144607, R01HL168188, and R01HL167974, the American Heart Association/Harold Amos Medical Faculty Development program, and Doris Duke Foundation Grant #2022051. Dr Jain has received consulting fees from Bristol Myers Squibb, ARTIS Ventures, and Broadview Ventures outside of the submitted work. Dr Bhatt has received research grant support to his institution from National Institutes of Health/National Heart, Lung, and Blood Institute, National Institutes of Health/National Institute on Aging, American College of Cardiology Foundation, and the Centers for Disease Control and Prevention; and has received consulting fees from Sanofi Pasteur, Merck, and Novo Nordisk. Dr Sandhu has received consulting fees from Lexicon Pharmaceuticals; and has received research funding from the American Heart Association, Novartis Pharmaceuticals, and Reprieve Cardiovascular outside of the submitted work. Dr Rodriguez has received equity from Carta Healthcare and HealthPals; and has received consulting fees from HealthPals, Novartis, NovoNordisk, Esperion Therapeutics, Movano Health, Kento Health, Inclusive Health, Edwards, Arrowhead Pharmaceuticals, HeartFlow, and iRhythm outside the submitted work. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Culturally-adapted evidence-based programs (EBPs) are needed to promote healthy behaviors among Native teens and young adults. Little is known about the facilitators and barriers of implementing and sustaining EBPs in Native communities. This paper aims to identify those factors described by educators who implemented the Native Students Together Against Negative Decisions (STAND) curriculum., Methods: We conducted qualitative, semi-structured interviews with 44 Native STAND educators from 48 sites throughout the United States. We used a modified grounded theory approach to explore barriers, facilitators, and sustainability factors related to implementing Native STAND., Results: We learned that disruptions to staffing, coordination, and organizational factors were the most common barriers. Factors that improved implementation success included: tailoring the program to local needs/constraints, having a supportive Project Manager, improved fidelity due to check-in calls, and participation in summer training. Factors that improved sustainability included: access to needed infrastructure, administrative support, community support, and student interest., Discussion: The delivery of Native STAND was further improved by person-to-person communication and resource sharing across sites. Sustaining EBPs in AI/AN settings requires culturally-tailored technical assistance, sufficient implementation funds for materials and staffing, and a community of peer educators to inspire forward progress., Conclusion: EBPs that reflect the needs and experiences of American Indian and Alaska Native (AI/AN) youth are necessary to address systemic inequities in adolescent health outcomes. The Native STAND Dissemination and Implementation study is among the first to assess facilitators and barriers to program delivery in diverse AI/AN settings., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: The impact of routine clinic use of patient-reported outcome (PRO) measures on clinical outcomes in patients with heart failure (HF) has not been well-characterized. We tested if clinic-based use of a disease-specific PRO improves patient-reported quality of life at 1 year., Methods: The PRO-HF trial (Patient-Reported Outcome Measurement in Heart Failure Clinic) was an open-label, parallel, patient-level randomized clinical trial of routine PRO assessment or usual care at an academic HF clinic between August 30, 2021, and June 30, 2022, with 1 year of follow-up. In the PRO assessment arm, participants completed the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) at each HF clinic visit, and results were shared with their treating clinician. The usual care arm completed the KCCQ-12 at randomization and 1 year later, which was not shared with the treating clinician. The primary outcome was the KCCQ-12 overall summary score (OSS) between 12 and 15 months after randomization. Secondary outcomes included domains of the KCCQ-12, hospitalization and emergency department visit rates, HF medication therapy, clinic visit frequency, and testing rates., Results: Across 17 clinicians, 1248 participants were enrolled and randomized to PRO assessment (n=624) or usual care (n=624). The median age was 63.9 years (interquartile range [IQR], 51.8-72.8), 38.9% were women, and the median baseline KCCQ-12 OSS was 82.3 (IQR, 58.3-94.8). Final KCCQ-12 (available in 87.9% of the PRO arm and 85.1% in usual care; P =0.16) median OSS were 87.5 (IQR, 68.8-96.9) in the PRO arm and 87.6 (IQR, 69.7-96.9) in the usual care arm with a baseline-adjusted mean difference of 0.2 ([95% CI, -1.7 to 2.0]; P =0.85). The results were consistent across prespecified subgroups. A post hoc analysis demonstrated a significant interaction with greater benefit among participants with a baseline KCCQ-12 OSS of 60 to 80 but not in less or more symptomatic participants. No significant differences were found in 1-year mortality, hospitalizations, emergency department visits, medication therapy, clinic follow-up, or testing rates between arms., Conclusions: Routine PRO assessment in HF clinic visits did not impact patient-reported quality of life or other clinical outcomes. Alternate strategies and settings for embedding PROs into routine clinical care should be tested., Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04164004., Competing Interests: Disclosures Dr Sandhu has consulted for Lexicon Pharmaceuticals and has research funding from Novartis and Reprieve Cardiovascular unrelated to this work. Dr Spertus owns the copyright to the Kansas City Cardiomyopathy Questionnaire. The interpretation and conclusions contained herein are those of the authors and do not necessarily represent the views of the National Institutes of Health.

Oregon expanded Emergency Medicaid coverage to 60 days of postpartum care in 2018, facilitating ongoing care for conditions such as gestational diabetes. We linked Medicaid claims and birth certificates from 2010 to 2019 in Oregon and South Carolina, which did not expand postpartum care. We used a difference-in-difference design to measure the effects of postpartum care coverage among Emergency Medicaid recipients with gestational diabetes. Primary outcomes were receipt of recommended glucose tolerance testing and new diagnosis of Type 2 diabetes. Our sample included 2,270 live births among a predominantly multiparous, Latina population. Postpartum coverage was associated with a significant increase in receipt of a recommended glucose tolerance test (23.1 percentage points, 95% CI 16.9-29.3) and in diagnosis of Type 2 diabetes (4.6 percentage points, 95% CI 3.3-65.9). Expansion of postpartum coverage increased recommended screenings and care among Emergency Medicaid enrollees with pregnancies complicated by gestational diabetes., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Importance: There are well-documented racial and ethnic disparities in effective contraceptive use due to multiple factors. A key contributor may be differential insurance coverage and patient costs. The Oregon Reproductive Health Equity Act (RHEA), enacted in 2017, ensures full coverage of reproductive health care without cost sharing for all Oregonians with low income., Objective: To assess whether removing financial barriers to accessing contraceptive care is associated with an improvement in use of moderately and highly effective contraceptive methods among Latina women compared with non-Latina women., Design, Setting, and Participants: This cohort study included women aged 12 to 51 years who sought contraceptive care in the Oregon Health Authority Reproductive Health Program from April 2016 to March 2020. Patients using permanent contraception, those missing data on ethnicity, and non-Oregon residents were excluded. Data analysis was performed in January 2021., Exposures: Contraceptive care in the Reproductive Health Program after RHEA implementation., Main Outcomes and Measures: The main outcome was prevalence of use of moderately effective methods (contraceptive pills, patch, ring, or injection) or highly effective methods (long-acting reversible contraceptives) at the time of the contraceptive visit. Difference-in-differences analysis was used to compare moderately and highly effective contraception use between Latina and non-Latina patients. Secondary outcomes were proportions of adoption or continuation of moderately and highly effective methods, prevalence of highly effective methods, and adoption or continuation of highly effective methods. The unit of analysis was at the clinic visit level., Results: The study sample consisted of 295 604 evaluable clinic visits, in which 28.4% of individuals identified as Latina and 71.6% of individuals identified as non-Latina. The mean (SD) age was 25.5 (8.1) years. With difference-in-differences analysis, there was a significant adjusted 1.9 percentage point (95% CI, 0.2-3.6 percentage points) increase in prevalence of moderately or highly effective contraceptive methods for Latina patients compared with non-Latina patients. There were no significant differences for other outcomes of interest., Conclusions: This cohort study found that in Oregon, legislation removing financial barriers to accessing contraceptive care was associated with significant mitigation in disparate moderately and highly effective contraceptive method prevalence for Latina patients compared with non-Latina patients. The findings suggest that state funds successfully supplanted federal funds to enable continued robust comprehensive family planning services after withdrawal from Title X.

Objectives: To understand how changes to in-person health care during the COVID pandemic impacted contraceptive use in Oregon's state-funded network., Study Design: A retrospective cohort of 245,600 visits (virtual and in-person) among 70,295 women presenting to publicly funded family planning clinics in Oregon between January 2019 and June 2021. Data were abstracted from clinic records and restricted to visits of patients identifying as female, 12-51 years old, not using sterilization as a method. Contraception was grouped by effectiveness Tier (Tier 1: intrauterine device, implants; Tier 2: progestin injectable, pill/patch/ring). Multivariable logistic regression predicted the use of contraception by stage of the COVID pandemic which corresponded to service availability (prepandemic, acute: nonemergency services halted, subacute: restricted services), patient demographics, including insurance type, and clinic and geospatial characteristics., Results: Overall during the acute stage, people with visits were more likely to leave with a method of contraception odds ratios (OR) 1.39 (95% confidence interval [CI] 1.24-1.57); however, it was significantly less likely to be a Tier 1 method (OR 0.82, 95% CI 0.74-0.91) as compared to prepandemic. This finding was particularly marked in rural areas (OR 0.69 [96% CI 0.58-0.83]) and among the publicly insured (OR 0.87 [95% CI 0.80-0.94])., Conclusions: Demand for contraception increased during the acute phase of the COVID pandemic, and shifts in method mix from Tier 1 to Tier 2 methods occurred. Disparities in contraceptive access persisted for those in rural locations or with public insurance., Implications: Lessons learned from the COVID-19 pandemic are critical to informing our future emergency response. The need for family planning services increased during the public health emergency., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Clinicians typically estimate heart failure health status using the New York Heart Association Class, which is often discordant with patient-reported health status. It is unknown whether collecting patient-reported health status improves the accuracy of clinician assessments., Methods: The PRO-HF trial (Patient-Reported Outcomes in Heart Failure Clinic) is a randomized, nonblinded trial evaluating routine Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) collection in heart failure clinic. Patients with a scheduled visit to Stanford heart failure clinic between August 30, 2021 and June 30, 2022 were enrolled and randomized to KCCQ-12 assessment or usual care. In this prespecified substudy, we evaluated whether access to the KCCQ-12 improved the accuracy of clinicians' New York Heart Association assessment or patients' perspectives on their clinician interaction. We surveyed clinicians regarding their patients' New York Heart Association Class, quality of life, and symptom frequency. Clinician responses were compared with patients' KCCQ-12 responses. We surveyed patients regarding their clinician interactions., Results: Of the 1248 enrolled patients, 1051 (84.2%) attended a visit during the substudy. KCCQ-12 results were given to the clinicians treating the 528 patients in the KCCQ-12 arm; the 523 patients in the usual care arm completed the KCCQ-12 without the results being shared. The correlation between New York Heart Association Class and KCCQ-12 Overall Summary Score was stronger when clinicians had access to the KCCQ-12 (r=-0.73 versus r=-0.61, P <0.001). More patients in the KCCQ-12 arm strongly agreed that their clinician understood their symptoms (95.2% versus 89.7% of respondents [odds ratio' 2.27; 95% CI' 1.32-3.87]). However, patients in both arms reported similar quality of clinician communication and therapeutic alliance., Conclusions: Collecting the KCCQ-12 in heart failure clinic improved clinicians' accuracy of health status assessment; correspondingly, patients believed their clinicians better understood their symptoms., Registration: URL: https://www., Clinicaltrials: gov; Unique identifier: NCT04164004.

Objective: To determine whether the timing of placement of long acting, reversible contraception (LARC) methods postpartum (immediate postpartum (IPP) or interval (within 6 months postpartum) is associated with higher removal rates by 12 months postpartum., Study Design: We conducted a retrospective cohort study using linked Medicaid claims and birth certificate data (n = 313,849) from Oregon and South Carolina from January 1, 2010 to December 31, 2018. Our primary outcome was LARC (intrauterine device (IUD) or implant) removal by 12 months postpartum. We compared crude proportions and rates of removal and used a multivariable survival analysis to compare removal over 12 months between IPP and interval LARC placement controlling for sociodemographic and clinical factors and clustered at the woman level., Results: Our sample included 313,849 births to 247,884 women; a majority did not receive any postpartum contraception (207,058 [66.0%]). Out of the 54,018 (17.2%) of births followed by an immediate postpartum or interval LARC placement, 11.8% discontinued by 12 months. In multivariable analyses, births followed by IPP LARC were 10% more likely to experience discontinuation at any point up to 12 months compared with interval LARC (HR: 1.10, 95% CI: 1.00-1.22), but this was not statistically significant., Conclusion: IPP LARC devices are removed at similar rates as LARC placed within 6 months postpartum., Implications: Timing of postpartum long acting reversible contraception- interval or immediately postpartum- was not associated with 12 month removal rates., (Copyright © 2022. Published by Elsevier Inc.)

Objective: To determine whether the type (intrauterine device or implant) or timing (immediately postpartum vs interval) of postpartum long-acting reversible contraception was associated with a reduction in short interpregnancy interval births., Study Design: We conducted a retrospective cohort study using linked Medicaid claims and birth certificate data from Oregon and South Carolina, 2010 to 2018. Our primary outcome was short interpregnancy interval, defined as repeat pregnancy within 18 months of the index delivery. We determined postpartum contraceptive method and timing of receipt. To assess the association of timing of long acting reversible contraception with short interpregnancy interval, we calculated adjusted probabilities from a logistic regression model incorporating covariate balanced propensity score weights, sociodemographic factors, and clustered at the woman-level., Results: Our study sample included 121,422 births to 97,084 individuals who had more than 1 birth during the study period; 41% had a short interpregnancy interval. A majority of individuals had not received any contraception by 6 months postpartum (68.6%). Overall, 15,477 individuals used long acting reversible contraception postpartum, with the majority receiving interval rather than immediate postpartum long acting reversible contraception (92.9% vs 7.1%). In multivariable analyses, both immediate postpartum (23.0%, 95% CI: 20.5%-25.8%) and interval long acting reversible contraception (15.2%, 95% CI: 14.4%-16.1%) are associated with a lower probability of short interpregnancy interval than short acting methods (42.1%, 95% CI: 41.2%-43.0%)., Conclusion: Compared to short-acting methods, receipt of both immediate postpartum and interval long-acting reversible contraception is associated with lower probabilities of a subsequent short interpregnancy interval., Implications: All long acting, reversible contraception, whether placed immediately postpartum or on an interval basis, was associated with a significantly lower probability of a short interpregnancy interval than short acting or no contraceptive method., Competing Interests: Declaration of Competing Interest Dr. Rodriguez's institution has received research funding from NIH, Arnold Ventures, Robert Wood Johnson Foundation, and Merck on grants for which she is the principal investigator. She has served as a contraceptive trainer for ACOG (current), Bayer (current), and Merck (relationship ended). Dr. Darney's institution receives research funding from the Office of Population (OPA) Affairs and Merck. These potential conflicts of interest are managed by OHSU's IRB. All other authors report no conflicts of interest., (Copyright © 2022. Published by Elsevier Inc.)

American Indian and Alaska Native (AI/AN) youth are strong in culture and rich in heritage and experience unique strengths and challenges throughout adolescence. Documenting conditions that protect against risk factors associated with poor health outcomes are needed. We explored scales that measure self-esteem, culture, social support, and community from a sample of 1,456 youth involved in Native STAND, a culturally-relevant evidence-based sexual health intervention. We established content validity by reviewing existing literature and community feedback. Construct validity was examined using factor analysis. The final self-esteem model included seven items, factor loadings ranged from 0.47 to 0.63 for positive self-esteem and 0.77 to 0.81 for negative self-esteem. The final culture model included three items, factor loadings 0.73 to 0.89. The social support scale included four items, factor loadings ranged from 0.86 to 0.87 for family social support and 0.75 to 0.77 for friends social support. The community and community safety scale included three items; factor loadings ranged from 0.52 to 0.82. Coefficient alphas for scales ranged from α = 0.63 to α = 0.86. This study validated scales in a national sample of AI/AN youth-psychometric scales provide an essential tool for documenting the needs and strengths of AI/AN youth., Competing Interests: The authors have declared that no competing interests exist.

Objective: We describe the first 24 months of expanded family planning services for low-income immigrants under Oregon's Reproductive Health Equity Act. We examined postabortion contraceptive use in rural versus urban locations., Study Design: We conducted a historical cohort study of abortion services reimbursed under the Reproductive Health Equity Act in the first 2 years after its implementation (2018 and 2019). Our primary outcome was shift in contraceptive tier from a less effective method before an abortion to a more effective contraceptive method after an abortion. Our key independent variable was residence in a metropolitan or nonmetropolitan area. We tested the association of nonmetropolitan residence and shift to a tier 1 or tier 2 method after the abortion, controlling for other factors, using logistic regression., Results: Our analysis included 625 abortions from across the state. After an abortion, 68% of women transitioned to a more effective form of contraception. Nonmetropolitan residence was not significantly associated with a shift from no method or a tier 3 method to tier 1 or tier 2 method (adjusted odds ratio, 1.28; 95% confidence interval, 0.81-2.02) compared with metropolitan residence., Conclusions: The program was successful in helping women not wishing pregnancy to transition to a more effective contraceptive method postabortion, regardless of metropolitan location of residence., (Copyright © 2021 Jacobs Institute of Women's Health, George Washington University. Published by Elsevier Inc. All rights reserved.)

Importance: Access to postpartum care is restricted for low-income women who are recent or undocumented immigrants enrolled in Emergency Medicaid., Objective: To examine the association of a policy extending postpartum coverage to Emergency Medicaid recipients with attendance at postpartum visits and use of postpartum contraception., Design, Setting, and Participants: This cohort study linked Medicaid claims and birth certificate data from 2010 to 2019 to examine changes in postpartum care coverage on postpartum care and contraception use. A difference-in-difference design was used to compare the rollout of postpartum coverage in Oregon with a comparison state, South Carolina, which did not cover postpartum care. The study used 2 distinct assumptions to conduct the analyses: first, preintervention differences in postpartum visit attendance and contraceptive use would have remained constant if the policy expanding coverage had not been passed (parallel trends assumption), and second, differences in preintervention trends would have continued without the policy change (differential trend assumption). Data analysis was performed from September 2020 to October 2021., Exposures: Medicaid coverage of postpartum care., Main Outcomes and Measures: Attendance at postpartum visits and postpartum contraceptive use, defined as receipt of any contraceptive method within 60 days of delivery., Results: The study population consisted of 27 667 live births among 23 971 women (mean [SD] age, 29.4 [6.0] years) enrolled in Emergency Medicaid. The majority of all births were to multiparous women (21 289 women [76.9%]; standardized mean difference [SMD] = 0.08) and were delivered vaginally (20 042 births [72.4%]; SMD = 0.03) and at term (25 502 births [92.2%]; SMD = 0.01). Following Oregon's expansion of postpartum coverage to women in Emergency Medicaid, there was a large and significant increase in postpartum care visits and contraceptive use. Assuming parallel trends, postpartum care attendance increased by 40.6 percentage points (95% CI, 34.1-47.1 percentage points; P < .001) following the policy change. Under the differential trends assumption, postpartum visits increased by 47.9 percentage points (95% CI, 41.3-54.6 percentage points; P < .001). Postpartum contraception use increased similarly. Under the parallel trends assumption, postpartum contraception within 60 days increased by 33.2 percentage points (95% CI, 31.1-35.4 percentage points; P < .001). Assuming differential trends, postpartum contraception increased by 28.2 percentage points (95% CI, 25.8-30.6 percentage points; P < .001)., Conclusions and Relevance: These findings suggest that expanding Emergency Medicaid benefits to include postpartum care is associated with significant improvements in receipt of postpartum care and contraceptive use.

Background: States have passed legislation to expand the scope of pharmacists to directly prescribe contraception. It is thought that pharmacist prescription of contraception may promote correct and consistent use of contraception by reducing barriers to access. However, it is not known how this may impact ongoing contraceptive use., Objective: This study aimed to determine whether 12-month rates of continuation of an effective form of contraception or perfect use of contraception differ by prescribing provider (pharmacist or clinician)., Study Design: We conducted a 1-year prospective cohort study of 388 women seeking contraception in 139 pharmacies across 4 states (California, Colorado, Hawaii, and Oregon). Our study was powered to detect a 10% difference in 12-month continuation of an effective form of contraception. We clarified women's pregnancy intention at baseline and subsequent follow-ups. Women received a prescription directly from a pharmacist (n=149) or were filling a prescription from a clinician, our comparison group (n=239). We used multivariable logistic regression to measure the association between pharmacist prescriber and use of any effective contraceptive method or perfect use at 12 months. Model covariates included age, race, education, side effects experienced, payor, and contraceptive supply dispensed at baseline., Results: Of the study cohort, 88% (n=340) completed 12 months of follow-up. Among women not planning to become pregnant, 7 women in the clinic-prescribed group vs 1 woman in the pharmacy-prescribed group (3.4% vs 0.8%; P>.05) reported a positive pregnancy test during the study period. The majority of the cohort was continuing to use an effective method of contraception at 12 months (clinician 89.3% vs pharmacist 90.4%; P=.86). Among women receiving a prescription from a clinician, 53.9% reported perfect use (no missed days) at 12 months, compared with 47% of the pharmacist-prescribed group (P=.69). Pharmacist prescriber type was not associated with continuation of an effective contraceptive method at 12 months (adjusted odds ratio, 0.70; confidence interval, 0.28-1.71) or with perfect use of contraception (adjusted odds ratio, 0.87; confidence interval, 0.51-1.48), controlling for other woman-level characteristics., Conclusion: We found no difference in use of any effective contraception, perfect use, or switching at 12 months among those who received their baseline prescription from a pharmacist vs a clinician. This study is limited by not examining information on safety outcomes., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objectives: To explore health behavior profiles of AI/AN youth involved in native students together against negative decisions (STAND), a national culture-based curriculum., Methods: We analyzed data from 1236 surveys conducted among AI/AN youth at 40 native STAND implementation sites located in 16 states throughout the US from 2014 to 2017. Health profiles included demographics, sexual orientation, sexual activity, STI testing, cigarette use, and suicide attempts in the past 12-months. We used t-tests and chi square tests of independence to compare risk behavior prevalence among the sample., Results: Health behavior profiles of AI/AN youth indicate that 45.6% of youth did not use condoms the last time they had sex, and 82.7% have never been tested for STIs. Differences in cigarette smoking were observed in questioning youth (questioning: 80.3%, straight/heterosexual: 63.8%, LGBTQ2S + : 49.9%, p = 0.03)., Conclusions for Practice: Health behaviors related to sex, substance, violence and self-harm, are at least as common for AI/AN youth as those observed in other US teens. Future research should consider similarities and differences in health profiles of AI/AN youth when designing interventions that affect them. Further, our findings underscore the need for culturally-relevant curricula like native STAND, not because their health behavior is different, but because their socio-ecologic environment is different., (© 2021. The Author(s).)

Background: The Emergency Medicaid program offers restricted Medicaid benefits for people who meet the same financial eligibility criteria as Traditional Medicaid recipients but do not meet the citizenship requirements for enrollment in Traditional Medicaid. By federal law, Emergency Medicaid covers care for life-threatening emergencies or a hospital admission for childbirth. No prenatal or postpartum care is covered. Most of the women enrolled in Emergency Medicaid are Latina., Objective: We assessed postpartum visits and receipt of postpartum contraception and compared the outcomes for Emergency (restricted benefit) Medicaid recipients with those of Traditional (full-benefit) Medicaid recipients in Oregon and South Carolina, 2 states with similar-sized immigrant populations., Study Design: We conducted a retrospective cohort study using linked Medicaid claims and birth certificate data of live births covered by Medicaid (Traditional and Emergency) between January 1, 2010 and September 30, 2017, in Oregon and South Carolina. Our analysis was at the individual level. Primary outcomes were postpartum visit attendance and receipt of postpartum contraception within 2 months. We examined differences in demographic and delivery characteristics by Medicaid type. If women received postpartum contraception, we compared the timing of receipt (immediate postpartum, ≤1 month, 1-2 months, and 2-6 months after delivery) by the type of Medicaid. Among women using contraception, we described the type of contraceptive received at each time point, stratified by Medicaid type. Associations between Medicaid type (Traditional vs Emergency) and postpartum visit attendance and contraception use were assessed using adjusted absolute predicted probabilities from logistic regression models. We ran models for the entire cohort and conducted a subanalysis restricted to only Latina women., Results: Our study included 375,544 live births to 288,234 women, with 12.7% of births among Emergency Medicaid recipients. Women enrolled in Emergency Medicaid tended to be older (age >35 years; 18.1% vs 7.2%; P <.001) and were more likely to be multiparous (76.8% vs 60.8%; P <.001) and Latina (80.3% vs 9.5%; P <.001) than their Traditional Medicaid peers. Among women enrolled in Emergency Medicaid, the probability of having a postpartum visit was 6.1% (95% confidence interval, 5.9-6.4) compared with 58.8% (95% confidence interval, 58.6-58.9) for women covered by Traditional Medicaid. After 6 months following delivery, 97.6% of Emergency Medicaid recipients had no evidence of contraceptive use compared with 55.6% of Traditional Medicaid enrollees ( P <.001). In our adjusted model, Emergency Medicaid recipients were also significantly less likely to receive postpartum contraception than Traditional Medicaid enrollees (1.9% vs 35.5%; 95% confidence interval, [1.8-2.1] vs [35.4-35.7]). We examined the role that race may play in postpartum contraceptive use by conducting a subanalysis restricted to Latina women only.Latinas with births covered by Emergency Medicaid had a 1.9% (95% confidence interval, 1.8-2.0) adjusted probability of postpartum contraception use within 2 months compared with 39.8% (95% confidence interval, 38.7-39.9) among Latinas enrolled in Traditional Medicaid., Conclusion: Women enrolled in Emergency Medicaid experience large disparities in postpartum care and contraceptive use. Policies that restrict Medicaid coverage following delivery exacerbate inequities in postpartum care, potentially leading to worse health outcomes for low-income immigrants and their children., (© 2021 The Authors.)

Objectives: We measured women's preferences for avoiding an unintended pregnancy. We determined if young age (<25) was associated with lowest utility with an unintended pregnancy., Study Design: We conducted a cross sectional study of women presenting for hormonal contraception who did not desire a pregnancy. We used four techniques to elicit health prefences and calculate utilities for an unintended pregnancy: visual analog scale, and willingness to pay, time-tradeoff (TTO), and standard gamble. We dichotomized each measure to define lowest utility for each measure. We used predicted probabilities and multivariable logistic regression to estimate the association between age (≤25 vs ≥26 y) and lowest utility with an unintended pregnancy., Results: Our sample included 419 participants from four states. We found that younger age (≤25) was positively associated with reporting the lowest utility for unintended pregnancy. In absolute terms, with the visual analog scale, the probability that a woman 25 years or younger would have lower preference for an unintended pregnancy was 26.8% (95% CI 20.4-33.2%) versus (21.7% (95% CI 14.3-29.0%). Using the willingness to pay, the probability of the younger group having lower preference was 84.9% (CI 80.3-89.4%) compared to 57.3% (CI 49.3-65.3). With the TTO, Women 25 years old and younger had a 78.3% probability (CI 72.6-84.0%) of low utility on the TTO vs 48.9% (CI 40.9-56.9%) in the older group. With standard gamble, younger women had a 47.0% probability (CI 36.8-50.6%) versus 18.0% (CI 14.7-27.5%)., Conclusions: Women of all ages report a decrease in health utility with unintended pregnancy. This decrease in health utility is greater among young women (age <25)., Implications: Health utilities for unintended pregnancy can be used to guide cost effectiveness research and health policy., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

This cohort study describes the first 24 months of abortion services covered under Oregon's Reproductive Health Equity Act and distances traveled by women to receive care., Competing Interests: Conflict of Interest Disclosures: Dr Rodriguez reported personal fees from the American Congress of Obstetrics and Gynecology, World Health Organization, and Bayer as well as grants from Merck, the National Institutes of Health, and Arnold Ventures outside the submitted work. No other disclosures were reported., (Copyright 2021 Rodriguez MI et al. JAMA Health Forum.)

Objective: To describe reasons for and experiences with obtaining contraception from pharmacists., Study Design: Cross-sectional survey., Results: Our sample included 426 women presenting for hormonal contraception (n = 150 pharmacist prescribers). The most common reasons women chose to obtain their contraception from a pharmacist were because no appointment was required (25%) or their prescription had lapsed (24%). Women receiving contraception from pharmacists were highly satisfied (95.3% vs 100.0%; p = 0.007). Women recalled similar side-effects counseling points regardless of prescriber type (p = 0.30)., Conclusion: Women chose to obtain contraceptive care at the pharmacy because it was timely and convenient., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Importance: Since 2016, 11 states have expanded the scope of pharmacists to include direct prescription of hormonal contraception. Dispensing greater than 1 month's supply is associated with improved contraceptive continuation rates and fewer breaks in coverage. Scant data exist on the practice of pharmacist prescription of contraception and its outcomes compared with traditional, clinic-based prescriptions., Objective: To compare the amount of hormonal contraceptive supply dispensed between pharmacists and clinic-based prescriptions. Prescribing patterns were assessed by describing prescribing practices for women with contraindications to combined hormonal contraception. Characteristics of women seeking hormonal contraception directly from pharmacists were also described., Design, Setting, and Participants: This cohort study surveyed women aged 18 to 50 years who presented to pharmacies in California, Colorado, Hawaii, and Oregon for hormonal contraception prescribed by a clinician or a pharmacist between January 30 and November 1, 2019., Exposures: Pharmacist or clinic-based prescription of contraception., Main Outcomes and Measures: Months of contraceptive supply dispensed., Results: Four hundred ten women (mean [SD] age, 27.1 [7.7] years) were recruited who obtained contraception directly from a pharmacist (n = 144) or by traditional clinician prescription (n = 266). Women obtaining contraception from a pharmacist were significantly younger (82 [56.9%] vs 115 [43.2%] participants aged 18-24 years; P = .03), had less education (38 [26.4%] vs 100 [37.6%] with a bachelor degree; P = .002), and were more likely to be uninsured (16 [11.1%] vs 8 [3.0%] participants; P = .001) compared with women with a prescription from a clinician. Pharmacists were significantly more likely to prescribe a 6-month or greater supply of contraceptives than clinicians (6.9% vs 1.5%, P < .001) and significantly less likely to only prescribe a 1-month supply (42 [29.2%] vs 118 [44.4%] prescriptions; P < .001). Controlling for all covariates, women seen by pharmacists had higher odds of receipt of a 6-month or greater supply of contraceptives compared with those seen by clinicians (odds ratio = 3.55; 95% CI, 1.88-6.70). Pharmacists were as likely as clinicians to prescribe a progestin-only method to women with a potential contraindication to estrogen (n = 60 women; 8 [20.0%] vs 6 [30.0%], P = .52)., Conclusions and Relevance: These findings suggest that pharmacist prescription of contraception may be associated with improved contraceptive continuation by preventing breaks in coverage through the provision of a greater supply of medication. Efforts are needed to educate prescribing providers on the importance of dispensing 6 months or greater contraceptive supply.