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Ongoing education on sexual health and other health promotion topics is critical as young people transition into adulthood. A booster round of education may be an effective strategy to reinforce information previously taught and expand to additional topics relevant later in adolescence. In partnership with a Youth Advisory Council, we co-designed READY, Set, Go!, a booster curriculum for older adolescents with modules covering adult preparation skills, sexual identity, relationships, reproductive health, and mental health. From November 2021 to January 2023, we provided the curriculum to 21 cohorts of 12th grade students (N = 433) in rural communities of Fresno County, CA, and conducted an implementation evaluation to assess its feasibility in school settings, acceptability by participants, and changes in short-term outcomes. Health educators completed implementation logs to track program adaptations. Youth completed pretest/posttest surveys to assess changes in outcomes and participant satisfaction. We used descriptive statistics to examine program adaptations and satisfaction. We used multivariable regression models to examine changes in outcomes, adjusted for sociodemographic characteristics. Health educators completed most activities as planned, with adaptations occurring in response to youth needs and scheduling limitations. Sexual health knowledge, confidence in adult preparation skills, awareness of local sexual and mental health services, and willingness to seek health services all increased significantly from pretest to posttest. Youth feedback was strongly positive. We conclude that booster sexual health education is a promising strategy to address critical knowledge gaps and support health promotion, especially in rural and other under-resourced communities.

ObjectivesPrior research identified a significant decline in the number of abortions in Louisiana at the onset of the COVID-19 pandemic, as well as increases in second-trimester abortions and decreases in medication abortions. This study examines how service disruptions in particular areas of the state disparately affected access to abortion care based on geography.Study designWe collected monthly service data from Louisiana's abortion clinics (January 2018-May 2020) and conducted mystery client calls to determine whether clinics were scheduling appointments at pandemic onset (April-May 2020). We used segmented regression to assess whether service disruptions modified the main pandemic effects on the number, timing, and type of abortions using stratified models and interaction terms. Additionally, we calculated the median distance that Louisiana residents traveled to the clinic where they obtained care.ResultsFor residents whose closest clinic was consistently scheduling appointments at the onset of the pandemic, the number of monthly abortions did not change (IRR = 1.07, 95% CI: 0.84-1.36). For those whose closest clinic services were disrupted, the number of monthly abortions decreased by 46% (IRR = 0.54, 95% CI: 0.45-0.65). Similarly, increases in second-trimester abortions and decreases in medication abortions were concentrated in areas where residents experienced service disruptions (AOR = 2.25, 95% CI: 1.21-4.56 and AOR = 0.59, 95% CI: 0.29-0.87, respectively) and were not seen elsewhere in the state.ConclusionChanges in the number, timing and type of abortions were concentrated among residents in particular areas of Louisiana. The early stages of the COVID-19 pandemic exacerbated geographic disparities in access to abortion care.ImplicationsDisruptions in services at the beginning of the COVID-19 pandemic in Louisiana meaningfully affected pregnant people's ability to obtain an abortion at their nearest clinic. These findings reinforce the importance of developing mechanisms to support pregnant people during emergency situations when traveling to a nearby clinic is no longer possible.

Despite national guidelines advocating a comprehensive, age-appropriate, and sequential approach to sexual health education in schools, many young people in the USA do not receive sexual health information until high school. To date, there has been little research on the need for a supplemental round of sexual health education -- a 'booster' -- later in adolescence to reinforce and expand upon information and skills previously provided. In rural California, we conducted six focus groups with young people (N = 22, ages 14-20) and key informant interviews with youth-serving professionals (N = 10) to examine the sexual health education needs of youth as they complete high school. Five themes were identified, indicating a need for booster education that 1) reinforces existing sexual health knowledge; 2) expands beyond traditional areas of sexual health education; 3) addresses community stigma about adolescent health; and 4) prepares young people for the transition to adulthood. In addition, booster education should 5) be established within the school system to promote an environment that addresses and normalises health issues throughout the school year. Providing booster sexual health education may meet critical gaps in efforts to support the healthy sexual development of young people, especially those living in rural communities.

Misinformation about abortion abounds in the United States. This may be due, in part, to laws in 22 states that require health care providers to present medically inaccurate or misleading information to people seeking abortion. Such information can negatively impact both providers and patients, particularly vulnerable populations who already face considerable challenges accessing abortion services. Health sciences librarians are a professional group whose core values prioritize access to evidence-based health information for all people, with the goal of facilitating informed health care decisions. This professional imperative suggests a role for librarians in the provision of evidence-based information around abortion. Drawing on our collective expertise in library science, medicine and public health, we propose that health sciences librarians build partnerships with public health departments and abortion providers to develop authoritative resources, advocate for change through legislative action, and raise public awareness about abortion misinformation.

Study objectiveTo understand the diverse reasons why some young women choose contraceptive methods that are less effective at preventing pregnancy, including condoms, withdrawal, and emergency contraception pills, even when more effective contraceptive methods are made available to them.DesignIn-depth interviews with young women at family planning clinics in July-November 2016. Interview data were thematically coded and analyzed using an iterative approach.SettingTwo youth-serving family planning clinics serving predominantly Latinx and African American communities in the San Francisco Bay Area, California.ParticipantsTwenty-two young women ages 15-25 years who recently accessed emergency contraception to prevent pregnancy.InterventionsNone.Main outcome measuresYoung women's experiences using different methods of contraception, with specific attention to methods that are less effective at preventing pregnancy.ResultsYoung women reported having previously used a range of higher- and lower-efficacy contraceptive methods. In interviews, they described affirmative values that drive their decision to use lower-efficacy methods, including: a preference for flexibility and spontaneity over continual contraceptive use, an emphasis on protecting one's body, and satisfaction with the method's effectiveness at preventing pregnancy. Some young women described using a combination of lower-efficacy methods to reduce their pregnancy risk.ConclusionYoung women make contraceptive decisions on the basis of preferences and values that include, but are not limited to, effectiveness at preventing pregnancy. These reasons are salient in their lives and need to be recognized as valid by sexual health care providers to ensure that young women receive ongoing high-quality care.

BackgroundPublic health agencies in the United States have engaged in abortion-related activities for nearly 50 years. Prior research indicates that, while most state health departments engage in some abortion-related work, their efforts reflect what is required by law rather than the breadth of core public health activities. In contrast, local health departments appear to engage in abortion-related activities less often but, when they do, initiate a broader range of activities.MethodsThis study aimed to: 1) describe the abortion-related activities undertaken by maternal and child health (MCH) and family planning professionals in state and local health departments; 2) understand how health departments approach their programmatic work on abortion, and 3) examine the facilitators and barriers to whether and how abortion work is implemented. Between November 2017 and June 2018, we conducted key informant interviews with 29 professionals working in 22 state and local health departments across the U.S. Interview data were thematically coded and analyzed using an iterative approach.ResultsMCH and family planning professionals described a range of abortion-related activities undertaken within their health departments. We identified three approaches to this work: those mandated strictly by law or policy; those initiated when mandated by law but informed by public health principles (e.g., scientific accuracy, expert engagement, lack of bias, promoting access to care) in implementation; and those initiated by professionals within the department to meet identified needs. More state health departments engaged in activities when mandated, and more local health departments initiated activities based on identified needs. Key barriers and facilitators included political climate, funding opportunities and restrictions, and departmental leadership.ConclusionsAlthough state health departments are tasked with implementing legally-required abortion-related activities, some agencies bring public health principles to their mandated work. Efforts are needed to engage public health professionals in developing and implementing best practices around engaging in abortion-related activities.

ContextPrevious research finds that some state policies regarding alcohol use during pregnancy (alcohol/pregnancy policies) increase low birth weight (LBW) and preterm birth (PTB), decrease prenatal care utilization, and have inconclusive relationships with alcohol use during pregnancy.ObjectiveThis research examines whether effects of 8 alcohol/pregnancy policies vary by education status, hypothesizing that health benefits of policies will be concentrated among women with more education and health harms will be concentrated among women with less education.MethodsThis study uses 1972-2015 Vital Statistics data, 1985-2016 Behavioral Risk Factor Surveillance System data, policy data from National Institute on Alcohol Abuse and Alcoholism's Alcohol Policy Information System and original legal research, and state-level control variables. Analyses include multivariable logistic regressions with education-policy interaction terms as main predictors.ResultsThe impact of alcohol/pregnancy policies varied by education status for PTB and LBW for all policies, for prenatal care use for some policies, and generally did not vary for alcohol use for any policy. Hypotheses were not supported. Five policies had adverse effects on PTB and LBW for high school graduates. Six policies had adverse effects on PTB and LBW for women with more than high school education. In contrast, 2 policies had beneficial effects on PTB and/or LBW for women with less than high school education. For prenatal care, patterns were generally similar, with adverse effects concentrated among women with more education and beneficial effects among women with less education. Although associations between policies and alcohol use during pregnancy varied by education, there was no clear pattern.ConclusionsEffects of alcohol/pregnancy policies on birth outcomes and prenatal care use vary by education status, with women with more education typically experiencing health harms and women with less education either not experiencing the harms or experiencing health benefits. New policy approaches that reduce harms related to alcohol use during pregnancy are needed. Public health professionals should take the lead on identifying and developing policy approaches that reduce harms related to alcohol use during pregnancy.

We examine characteristics and experiences of women who considered, but did not have, an abortion for this pregnancy. Participants were recruited at prenatal care clinics in Louisiana and Maryland for a mixed-methods study (N = 589). On self-administered surveys and structured interviews, participants were asked if they had considered abortion for this pregnancy and, if so, reasons they did not obtain one. A subset (n = 83), including participants who considered abortion for this pregnancy, completed in-depth phone interviews. Multivariable logistic regression analyses examined characteristics associated with having considered abortion and experiencing a policy-related barrier to having an abortion; analyses focused on economic insecurity and of mental health/substance use as main predictors of interest. Louisiana interviews (n = 43) were analyzed using modified grounded theory to understand concrete experiences of policy-related factors. In regression analyses, women who reported greater economic insecurity (aOR 1.21 [95% CI 1.17, 1.26]) and more mental health diagnoses/substance use (aOR 1.29 [1.16, 1.45] had higher odds of having considered abortion. Those who reported greater economic insecurity (aOR 1.50 [1.09, 2.08]) and more mental health diagnoses/substance use (aOR 1.45 [95% CI 1.03, 2.05] had higher odds of reporting policy-related barriers. Interviewees who considered abortion and were subject to multiple restrictions on abortion identified material and instrumental impacts of policies that, collectively, contributed to them not having an abortion. Many described simultaneously navigating economic insecurity, mental health disorders, substance use, and interpersonal opposition to abortion from family and the man involved in the pregnancy. Current restrictive abortion policies appear to have more of an impact on women who report greater economic insecurity and more mental health diagnoses/substance use. These policies work in concert with each other, with people's individual complex situations-including economic insecurity, mental health, and substance use-and with anti-abortion attitudes of other people to make abortion care impossible for some pregnant women to access.

ObjectiveIn recent years, in an attempt to counter stigma and increase empathy, public education campaigns have encouraged people to share their personal abortion stories. This exploratory study sought to document negative and positive experiences of those who have shared their abortion stories publicly.Study designWe conducted an anonymous online survey of people who have shared their abortion story publicly (N = 88), recruited via partners affiliated with two abortion story-sharing campaigns. The survey asked about the context in which respondents shared their abortion story, any negative and positive experiences online and in "real life" as a result of story sharing, and any problems or benefits resulting from these experiences. We analyzed survey data using descriptive statistics, bivariate analyses and categorizing responses to open-ended questions.ResultsSixty percent of respondents reported experiencing harassment and other negative incidents after sharing their story publicly. These experiences contributed to emotional stress, problems with loved ones and difficulties at work and/or school. These harms were reported even by many respondents who used only a first name or alias when sharing their story. Despite this, positive experiences as a result of story sharing were reported by four out of five respondents and motivated many to continue sharing their story.ConclusionsThis exploratory study indicates that many people who share their abortion story publicly find it to be an empowering, rewarding experience. Yet they also experience harassment and threats at high rates. Future research should explore both positive and negative experiences in more depth.ImplicationsSharing one's personal abortion story as part of a public education campaign can be a positive, empowering experience. Nevertheless, policymakers, journalists and reproductive health advocates should recognize the potential harms experienced by people who share their abortion story publicly and consider measures to support these individuals.

Attempts to solve the "problem of adolescent pregnancy" have long been a  focus of national, state, and local efforts in the United States. This review article summarizes trends and strategies around adolescent pregnancy prevention, provides lessons learned and best practices, and presents ideas for future directions. Over the past decades, a wide variety of policy and programmatic interventions have been implemented - including educational efforts, clinical health services, and community-wide coalitions - accompanied by a growing consensus regarding viable solutions. While notable reductions in adolescent pregnancy and childbearing have occurred across all sociodemographic groups, racial/ethnic, geographic, and socioeconomic disparities persist. Many adolescents who most need sexual health information and services are underserved by current programs and policies. A growing understanding of the role of social determinants of health, the impacts of structural racism, and the need for equity and inclusion must inform the next set of interventions and societal commitments to not only ameliorate the occurrence of unintended adolescent pregnancy but also foster healthy adolescent development. Recommendations for future efforts include improving the content, quality, and sustainability of education programs; actively engaging youth in the design of policies, programs, and clinical services; using technology thoughtfully to improve health literacy; expanding access to services through telehealth and other delivery options; and designing programs and policies that recognize and address structural racism, health equity, and inclusion.

PurposeStates have enacted an increasing number of policies restricting access to abortion. As a result, some women are unable to obtain an abortion and instead continue their pregnancies. These women may have particular needs that would bring them to the attention of public health programs.MethodsPregnant women entering prenatal care completed a self-administered survey and structured interview at four prenatal facilities in Louisiana and Maryland (N = 586). Participants reported their pregnancy intentions, whether they had considered abortion, and their reasons for not having an abortion (e.g., personal reasons, policy barriers to care). Participants completed up to 13 items indicating their service needs; an index was created by summing across nine common items. Data were analyzed through descriptive statistics, bivariate analyses, and multivariable regression models that controlled for sociodemographic characteristics.ResultsOn average, women reported 2.99 service needs. The most common needs were WIC (93%), food stamps (85%), dental care (59%), and housing assistance (53%). In multivariable analyses, women who considered abortion but did not face a policy barrier reported greater service needs compared to women who did not consider abortion (3.45 vs. 2.82; b = 0.64; 95% confidence interval, 0.25-1.04). Women reporting a policy barrier to abortion reported the highest service needs (3.95) of all groups, although differences were not statistically significant possibly owing to sample size.ConclusionsPregnant women who consider abortion before entering prenatal care have considerable health and social service needs. Public health programs that serve women and children should consider the specific needs of women who seek abortions.

BackgroundIn recent years, an increasing number of states have enacted laws that impose specific requirements for facilities in which abortions are performed. In this study, we sought to understand the processes used to develop facility standards in the context of other, less politically charged areas of health care and consider implications for the context of abortion.MethodsWe conducted key informant interviews with 20 clinicians and accreditation professionals involved in facility standards development for common outpatient procedures (endoscopy, gynecology, oral surgery, plastic surgery). We examined the motivations for and processes used in facility standards development, use of scientific evidence in standards development, and decision-making in the absence of evidence. Interview data were thematically coded and analyzed using an iterative approach.ResultsIn contrast to U.S. state laws that target abortion facilities, standards for other outpatient procedures are commonly set by committees of clinicians organized by professional associations or accreditation organizations. These committees seek to establish standards that ensure patient safety without placing unnecessary burden on clinicians in practice. They aim to create evidence-based standards but can be hampered by lack of relevant research. In the absence of research evidence, committees rely on their clinical expertise and sense of best practices in decision-making. According to respondents, considerations of potential harm (e.g., deeper levels of sedation, invasiveness), rather than the specific procedure, should prompt additional requirements.ConclusionsIf facility standards in the context of abortion were developed through processes similar to other outpatient procedures, 1) professionals who perform the procedure would be involved in standards development and 2) in the absence of clear research evidence, the expertise of clinicians, and the guidelines and standards of other organizations, are used to describe a best practice standard of care.

BackgroundProfessional guidelines indicate that pregnancy options counseling should be offered to pregnant women, in particular those experiencing an unintended pregnancy. However, research on whether pregnancy options counseling would benefit women as they enter prenatal care is limited. This study examines which women might benefit from options counseling during early prenatal care and whether women are interested in receiving counseling from their prenatal care provider.MethodsAt four prenatal care facilities in Louisiana and Maryland, women entering prenatal care completed a self-administered survey and brief structured interview (N = 586). Data were analyzed through descriptive statistics, bivariate analyses, multivariate multinomial logistic regression, and coding of open-ended responses.ResultsAt entry into prenatal care, most women reported that they planned to continue their pregnancy and raise the child. A subset (3%) scored as having low certainty about their decision on the validated Decision Conflict Scale, indicating need for counseling. In addition, 9% of women stated that they would be interested in discussing their pregnancy options with their prenatal care provider. Regression analyses indicated some sociodemographic differences among women who are in need of or interested in options counseling. Notably, women who reported food insecurity in the prior year were found to be significantly more likely to be in need of options counseling (RRR = 3.20, p

Introduction Prior research shows that maternal and child health (MCH) and family planning (FP) divisions in health departments (HDs) engage in some abortion-related activities, largely when legally mandated; some agencies also initiate abortion-related activities. Yet little is known about health department MCH/FP professionals' views on how abortion-related work aligns with their professional mission. Methods Between November 2017 and June 2018, we conducted in-depth interviews with 29 MCH/FP professionals working in 22 state and local HDs across the U.S. We conducted inductive thematic analysis to identify themes regarding participants' professional mission and values in relation to abortion-related work. Results Participants described a strong sense of professional mission. Two contrasting perspectives on abortion and the MCH/FP mission emerged: some participants saw abortion as clearly outside the scope of their mission, even a threat to it, while others saw abortion as solidly within their mission. In states with supportive or restrictive abortion policy environments, professionals' views on abortion and professional mission generally aligned with their overall state policy environment; in states with middle-ground abortion policy environments, a range of perspectives on abortion and professional mission were expressed. Participants who saw abortion as within their mission anchored their work in core public health values such as evidence-based practice, social justice, and ensuring access to health care. Discussion There appears to be a lack of consensus about whether and how abortion fits into the mission of MCH/FP. More work is needed to articulate whether and how abortion aligns with the MCH/FP mission., Author(s): Katie Woodruff [sup.1] , Erin Wingo [sup.1] , Nancy F. Berglas [sup.1] , Sarah C. M. Roberts [sup.1] Author Affiliations: (1) grid.266102.1, 0000 0001 2297 6811, Advancing New Standards [...]

ContextRecent legislation in states across the United States has required governmental health agencies to take on new and different roles in relation to abortion. While there has been media attention to health department roles in regulating abortion providers, there has been no systematic investigation of the range of activities in which state and local health departments are engaged.ObjectiveTo systematically investigate health department activities related to abortion.MethodsWe searched state health department Web sites of the 50 states and District of Columbia using key words such as "abortion" and "pregnancy termination". Two trained coders categorized 6093 documents using the 10 Essential Public Health Services (EPHS) framework. We then applied these methods to 671 local health department documents.SettingState and local health department Web sites.ParticipantsN/A.ResultsOn average, states engaged in 5.1 of 10 Essential Services related to abortion. Most (76%-98%) state health departments engaged in activities to Monitor Health Status (EPHS1), Enforce Laws (EPHS6), and Evaluate Effectiveness, Accessibility, and Quality (EPHS9). Many (47%-69%) engaged in activities to Inform and Educate (EPHS3), Develop Policies (EPHS5), and Link to Services (EPHS7). A minority (4%-29%) engaged in activities to Diagnose and Investigate Health Problems (EPHS2), Mobilize Community Partnerships (EPHS4), and Assure Competent Workforce (EPHS8). No state engaged in Innovative Research (EPHS10). Few local health departments engaged in abortion-related activities.ConclusionsWhile most state health departments engage in abortion-related activities, they appear to reflect what the law requires rather than the range of core public health activities. Additional research is needed to assess whether these services meet quality standards for public health services and determine how best to support governmental health agencies in their growing tasks. These findings raise important questions about the role of public health agencies and professionals in defining how health departments should be engaging with abortion.

BackgroundOver recent decades, numerous medical procedures have migrated out of hospitals and into freestanding ambulatory surgery centers (ASCs) and physician offices, with possible implications for patient outcomes. In response, states have passed regulations for office-based surgeries, private organizations have established standards for facility accreditation, and professional associations have developed clinical guidelines. While abortions have been performed in office setting for decades, states have also enacted laws requiring that facilities that perform abortions meet specific requirements. The extent to which facility requirements have an impact on patient outcomes-for any procedure-is unclear.Methods and findingsWe conducted a systematic review to examine the effect of outpatient facility type (ASC vs. office) and specific facility characteristics (e.g., facility accreditation, emergency response protocols, clinician qualifications, physical plant characteristics, other policies) on patient safety, patient experience and service availability in non-hospital-affiliated outpatient settings. To identify relevant research, we searched databases of the published academic literature (PubMed, EMBASE, Web of Science) and websites of governmental and non-governmental organizations. Two investigators reviewed 3049 abstracts and full-text articles against inclusion/exclusion criteria and assessed the quality of 22 identified articles. Most studies were hampered by methodological challenges, with 12 of 22 not meeting minimum quality criteria. Of 10 studies included in the review, most (6) examined the effect of facility type on patient safety. Existing research appears to indicate no difference in patient safety for outpatient procedures performed in ASCs vs. physician offices. Research about specific facility characteristics is insufficient to draw conclusions.ConclusionsMore and higher quality research is needed to determine if there is a public health problem to be addressed through facility regulation and, if so, which facility characteristics may result in consistent improvements to patient safety while not adversely affecting patient experience or service availability.

In the United States, groups advocating for and against abortion rights often deploy public health arguments to advance their positions. Recently, these arguments have evolved into state laws that use the government health department infrastructure to increase law enforcement and regulatory activities around abortion. Many major medical and public health associations oppose these new laws because they are not evidence-based and do not protect women's health. Yet state health departments have been defending these laws in court. We propose a 21st-century public health approach to abortion based in an accepted public health framework. Specifically, we apply the Centers for Disease Control and Prevention's 10 Essential Public Health Services framework to abortion to describe how health departments should engage with abortion. With this public health framework as our guide, we argue that health departments should be facilitating women's ability to obtain an abortion in the state and county where they reside, researching barriers to abortion care in their states and counties, and promoting the use of a scientific evidence base in abortion-related laws, policies, regulations, and implementation of essential services.

PurposeThe extent that state-mandated informed consent scripts affect women's knowledge about abortion is unknown. We examine women's endorsement of common abortion myths before and after receiving state-mandated information that included accurate and inaccurate statements about abortion.MethodsIn Utah, women presenting for an abortion information visit completed baseline surveys (n = 494) and follow-up interviews 3 weeks later (n = 309). Women answered five items about abortion risks, indicating which of two statements was closer to the truth (as established by prior research) or responding "don't know." We developed a continuous myth endorsement scale (range, 0-1) and, using multivariable regression models, examined predictors of myth endorsement at baseline and change in myth endorsement from baseline to follow-up.ResultsAt baseline, many women reported not knowing about abortion risks (range, 36%-70% across myths). Women who were younger, non-White, and had previously given birth but not had a prior abortion reported higher myth endorsement at baseline. Overall, myth endorsement decreased after the information visit (0.37-0.31; p

Objective No studies have examined whether alcohol taxes may be relevant for reducing harms related to pregnant people's drinking. Method We examined how beverage-specific ad valorem , volume-based, and sales taxes are associated with outcomes across three data sets. Drinking outcomes came from women of reproductive age in the 1990–2020 US National Alcohol Surveys (N  = 11 659 women |$\le$| 44 years); treatment admissions data came from the 1992–2019 Treatment Episode Data Set: Admissions (N  = 1331 state-years; 582 436 pregnant women admitted to treatment); and infant and maternal outcomes came from the 2005–19 Merative Marketscan® database (1 432 979 birthing person–infant dyads). Adjusted analyses for all data sets included year fixed effects, state-year unemployment and poverty, and accounted for clustering by state. Results Models yield no robust significant associations between taxes and drinking. Increased spirits ad valorem taxes were robustly associated with lower rates of treatment admissions [adjusted IRR = 0.95, 95% CI: 0.91, 0.99]. Increased wine and spirits volume-based taxes were both robustly associated with lower odds of infant morbidities [wine aOR = 0.98, 95% CI: 0.96, 0.99; spirits aOR = 0.99, 95% CI: 0.98, 1.00] and lower odds of severe maternal morbidities [wine aOR = 0.91, 95% CI: 0.86, 0.97; spirits aOR = 0.95, 95% CI: 0.92, 0.97]. Having an off-premise spirits sales tax was also robustly related to lower odds of severe maternal morbidities [aOR = 0.78, 95% CI: 0.64, 0.96]. Conclusions Results show protective associations between increased wine and spirits volume-based and sales taxes with infant and maternal morbidities. Policies that index tax rates to inflation might yield more public health benefits, including for pregnant people and infants. [ABSTRACT FROM AUTHOR]

Through considerable efforts and investments of resources, adolescent pregnancy and birth rates in the United States have decreased significantly over the past two decades. Nonetheless, large disparities persist for many populations of youth. Reducing unintended adolescent pregnancies is considered a “winnable public health battle,” but one that will require innovative thinking and continued persistence. This paper reviews the recent research literature and innovative programmatic efforts to identify six promising strategies that address the challenge of adolescent pregnancy in new ways. These strategies aim to: (1) understand and address the complexity of adolescent lives; (2) expand the provision of quality sexual health education; (3) engage youth through technology and media; (4) increase access to contraceptives and other sexual health services; (5) create tailored interventions for populations with special needs; and (6) create a supportive policy environment. By building upon lessons learned from past efforts, we can move the field toward the development, strengthening, and promotion of future strategies that enhance the sexual well-being of all adolescents.

Adolescence is a common time for sexual initiation and information seeking about sexual health, yet little is known about how adolescents' sources of information about sex influence their sexual beliefs and behaviors. This is particularly true for Latino adolescents, whose sources of sex information and sexual behaviors are vastly understudied. A survey of ninth-grade Latino adolescents (N = 1,186) was employed to examine the relationship between adolescents' primary source of sex information and their intention to use condoms. The study also examined the potential influences of demographics (age, gender), sociodemographics (socioeconomic status, parent education, and linguistic acculturation), and sexual experience on condom use intention. Among Latino youth, the most commonly reported source of sex information was parents (37.8%), followed by another relative (17.1%), school (13.4%), and friends (11.4%). Hierarchical regression analyses showed that after controlling for other factors, primary source of sex information was significantly associated with condom use intention (p = 0.042). Hierarchical regression results stratified by gender showed that this relationship remained significant for males (p = 0.004) but not for females (p = 0.242). Males who reported friends (odds ratio [OR] = 0.44, p = 0.003) or the media/Internet (OR = 0.44, p = 0.008) as their primary sources of sex information, as compared to parents as their primary source, reported significantly lower intention to use condoms. These findings suggest it may be important for Latino adolescents, particularly males, to have additional or other sources for sex information in order to promote healthy sexual behaviors. Alternatively, interventions targeting parents or other family members to improve sexual health communication with adolescent boys may prove essential.

Despite national guidelines advocating a comprehensive, age-appropriate, and sequential approach to sexual health education in schools, many young people in the USA do not receive sexual health information until high school. To date, there has been little research on the need for a supplemental round of sexual health education – a 'booster' – later in adolescence to reinforce and expand upon information and skills previously provided. In rural California, we conducted six focus groups with young people (N = 22, ages 14–20) and key informant interviews with youth-serving professionals (N = 10) to examine the sexual health education needs of youth as they complete high school. Five themes were identified, indicating a need for booster education that 1) reinforces existing sexual health knowledge; 2) expands beyond traditional areas of sexual health education; 3) addresses community stigma about adolescent health; and 4) prepares young people for the transition to adulthood. In addition, booster education should 5) be established within the school system to promote an environment that addresses and normalises health issues throughout the school year. Providing booster sexual health education may meet critical gaps in efforts to support the healthy sexual development of young people, especially those living in rural communities. [ABSTRACT FROM AUTHOR]

Aims We examined relationships between pregnancy-specific alcohol policies and admissions to substance use disorder treatment for pregnant people in the USA. Methods We merged state-level policy and treatment admissions data for 1992–2019. We aggregated data by state-year to examine effects of nine pregnancy-specific alcohol policies on the number of admissions of pregnant women where alcohol was reported as the primary, secondary, or tertiary substance related to the treatment episode (N  = 1331). We fit Poisson models that included all policy variables, state-level controls, fixed effects for state and year, state-specific time trends, and an offset variable of the number of pregnancies in the state-year to account for differences in population size and fertility. Results When alcohol was reported as the primary substance, civil commitment [incidence rate ratio (IRR) 1.45, 95% CI: 1.10–1.89] and reporting requirements for assessment and treatment purposes [IRR 1.36, 95% CI: 1.04–1.77] were associated with greater treatment admissions. Findings for alcohol as primary, secondary, or tertiary substance were similar for civil commitment [IRR 1.31, 95% CI: 1.08–1.59] and reporting requirements for assessment and treatment purposes [IRR 1.21, 95% CI: 1.00–1.47], although mandatory warning signs [IRR 0.84, 95% CI: 0.72–0.98] and priority treatment for pregnant women [IRR 0.88, 95% CI: 0.78–0.99] were associated with fewer treatment admissions. Priority treatment findings were not robust in sensitivity analyses. No other policies were associated with treatment admissions. Conclusions Pregnancy-specific alcohol policies related to greater treatment admissions tend to mandate treatment rather than make voluntary treatment more accessible, raising questions of ethics and effectiveness. [ABSTRACT FROM AUTHOR]

Objective: Although Hispanic adolescents in the USA are often the focus of sexual health interventions, their response to survey measures has rarely been assessed within evaluation studies. This study documents the test-retest reliability of a wide range of self-reported sexual health values, attitudes, knowledge and behaviours among Hispanic adolescents from low-income, urban communities. Method: Intraclass correlation coefficients were calculated for sexual health scales (knowledge, values about condom use, parent communication, protection self-efficacy and condom-use intentions) in a 2-week sample (N = 86). Cohen's kappa and intraclass correlation coefficients were calculated for behaviours (romantic and sexual behaviours, and sexual health services history) in two separate 2-week samples (N = 86, N = 202). Selected behaviours were also examined for retractions in both 2-week samples and in a 1-year sample (N = 291). Results: Among sexual health scales, test-retest reliability ranged from 0.37 for condom-use intentions to 0.93 for parent communication. Among behaviours, reliability ranged from .27 for use of sexual health services to 1.00 for use of birth control at first sex. Retractions ranged from below 10% for ever having had a steady partner to 50% or more for sexual health services and testing. Conclusion: Test-retest reliability differed greatly across self-reported sexual health values, attitudes, knowledge and behaviours for the three samples of Hispanic adolescents. Overall, however, most items and scales showed good to excellent reliability (i.e. a coefficient greater than 0.60), suggesting that Hispanic adolescents are moderately to highly stable reporters in response to sexual health measures.

Numerous classroom-based interventions have aimed to improve sexual health outcomes for young people, yet few have shown strong, lasting effects. Ecological approaches that address multiple levels of a young person's environment offer largely untapped potential to positively change sexual behaviour. This paper presents results of a cluster-randomised trial of a multicomponent sexuality education intervention that integrated a classroom curriculum, parent education workshops and materials, peer advocate programme, and sexual health services at 10 urban high schools. An implementation evaluation, employing quantitative and qualitative instruments, was conducted to examine whether the individual components of the intervention were delivered as planned and how they were received by the target populations. Multilevel modelling was used to evaluate the effect of the multicomponent intervention on outcomes at one-year follow-up. Results showed that the intervention components were successfully implemented with and well received by target populations. Students receiving the multicomponent intervention reported greater increases in the use of sexual health services (odds ratio [OR] = 1.73, 95% CI = 1.09-2.75) and the likelihood of carrying a condom (OR = 2.71, 95% CI = 1.44-5.09) relative to those receiving a control condition. No effects were found for other behaviours, possibly due to low prevalence of sexual activity in the sample and the small number of schools randomised.

Given the politicization of abortion, professionals working in U.S. health departments (HDs) may not be receptive to communications about abortion, despite often regulating abortion facilities. This paper reports results of a randomized, prospective, observational study to test the effects of e-mail language when disseminating evidence on abortion to HD professionals. Our sample was 302 HD employees who oversee healthcare facilities inspection/regulation in all 50 U.S. state HDs, clustered by HD and randomized into two study groups. In November–December 2019, we sent biweekly e-mails containing links to a website summarizing evidence on abortion facility regulation. E-mails/headers sent to one group emphasized public health values and did not include the word abortion; e-mails/headers to the other group used the word abortion. Primary outcome measures were e-mail open rates and click-through rates. Among 221 participants to whom e-mails were deliverable, the overall open rate was 36%. Open rate was 25% for PH values and 46% for abortion groups (p <.05). Effects were moderated by state abortion policy environment: in both supportive and restrictive environments, participants in the abortion messaging group were statistically more likely to open e-mails than those in the PH values group. There was no difference between groups in states with middle-ground abortion policy environments. Among participants opening at least one e-mail, 19% clicked through to the website, with no significant difference by group. This study demonstrates that repeated targeted e-mail campaigns can reach HD professionals with research summaries. Concerns that communications to HDs should avoid the word abortion are unsupported. [ABSTRACT FROM AUTHOR]

The objective of this study was to determine the prevalence of a lifetime history of illicit drug dependence-abuse among hospitalized patients, and to determine the rate of identification of these patients by physicians. This cross-sectional study included patient interview and chart review in an acute-care teaching hospital. The participants were 235 randomly selected inpatients with medical, neurologic, or surgical diagnoses. The prevalence of lifetime history of dependence-abuse of at least one class of illicit drug was 11.9%. Across all classes of drugs, hospitalized patients had higher prevalences than community estimates. Only 18% of patients had documentation of having been asked about illicit drug use compared to 49% having been asked about alcohol use. There was no significant difference in physicians' asking across clinical services: Medicine 21 %, Neurology 15%, Surgery 14%. Smokers, unmarried persons, and patients without a regular physician were most likely to have been asked. Screening for drug abuse is not routinely performed and documented among hospitalized patients. Wider identification of persons at risk for drug use may allow for specific physician interventions., INTRODUCTION Illicit drug abuse is a major public health problem in the United States. The Epidemiologic Catchment Area (ECA) Study and the National Comorbidity Survey sampled communities for the lifetime [...]

Objectives. To examine changes in abortions in Louisiana before and after the COVID-19 pandemic onset and assess whether variations in abortion service availability during this time might explain observed changes. Methods. We collected monthly service data from abortion clinics in Louisiana and neighboring states among Louisiana residents (January 2018‒May 2020) and assessed changes in abortions following pandemic onset. We conducted mystery client calls to 30 abortion clinics in Louisiana and neighboring states (April‒July 2020) and examined the percentage of open and scheduling clinics and median waits. Results. The number of abortions per month among Louisiana residents in Louisiana clinics decreased 31% (incidence rate ratio = 0.69; 95% confidence interval [CI] = 0.59, 0.79) from before to after pandemic onset, while the odds of having a second-trimester abortion increased (adjusted odds ratio [AOR] = 1.91; 95% CI = 1.10, 3.33). The decrease was not offset by an increase in out-of-state abortions. In Louisiana, only 1 or 2 (of 3) clinics were open (with a median wait > 2 weeks) through early May. Conclusions. The COVID-19 pandemic onset was associated with a significant decrease in the number of abortions and increase in the proportion of abortions provided in the second trimester among Louisiana residents. These changes followed service disruptions. [ABSTRACT FROM AUTHOR]

Numerous classroom-based interventions have aimed to improve sexual health outcomes for young people, yet few have shown strong, lasting effects. Ecological approaches that address multiple levels of a young person’s environment offer largely untapped potential to positively change sexual behaviour. This paper presents results of a cluster-randomised trial of a multicomponent sexuality education intervention that integrated a classroom curriculum, parent education workshops and materials, peer advocate programme, and sexual health services at 10 urban high schools. An implementation evaluation, employing quantitative and qualitative instruments, was conducted to examine whether the individual components of the intervention were delivered as planned and how they were received by the target populations. Multilevel modelling was used to evaluate the effect of the multicomponent intervention on outcomes at one-year follow-up. Results showed that the intervention components were successfully implemented with and well received by target populations. Students receiving the multicomponent intervention reported greater increases in the use of sexual health services (odds ratio [OR] = 1.73, 95% CI = 1.09–2.75) and the likelihood of carrying a condom (OR = 2.71, 95% CI = 1.44–5.09) relative to those receiving a control condition. No effects were found for other behaviours, possibly due to low prevalence of sexual activity in the sample and the small number of schools randomised. [ABSTRACT FROM PUBLISHER]

Objective: Develop and validate measures of adolescents' attitudes about sexual relationship rights.Methods: Items were completed by students in a large U.S. city (N= 655). The authors conducted an exploratory factor analysis, evaluated internal consistency, and assessed construct validity, including ability to predict sexual behavior at 1-year follow-up.Results: Factor analysis identified 2 distinct factors, comprising attitudes about rights to refuse unwanted sexual activity (5 items) and express sexual engagement needs (5 items) in a sexual relationship. The measures showed sound evidence of reliability and construct validity.Conclusions: The psychometric evidence supports the use of these measures in adolescent sexual health research. [ABSTRACT FROM AUTHOR]

Background: The study aimed to understand the influence of predisposing, enabling and need-for-care factors on adolescents' intention to use sexual health services, using Andersen's Behavioural Model of Health Service Utilisation to organise and test these factors.Methods: A sample of predominantly Hispanic teens (n=600) in Los Angeles, California completed a self-report survey about their sexual health knowledge, beliefs, intentions, and behaviours. Hierarchical regression modelling was used to examine the incremental influences on adolescents' intention to use sexual health services of: 1) predisposing sociodemographic factors; 2) predisposing knowledge and beliefs about sexual health; 3) enabling factors regarding perceived access to sexual health services; and 4) a need-for-care factor (sexual experience).Results: Adolescents reported high intentions to use sexual health services (3.25 on a 4-point scale), yet only 42% reported knowing where to access services. Sexual health knowledge and beliefs significantly predicted adolescents' intention to use services beyond the effect of sociodemographics (P<0.001). Enabling factors indicating awareness of and importance attributed to accessibility significantly predicted intention to use services incremental to predisposing factors (P<0.001). However, need for care - that is, sexual experience - was not statistically associated with intention to use services (P=0.402).Conclusions: Sexual health interventions are needed to provide sexual health information, promote positive beliefs about health care, and ensure adolescents' awareness of and access to sexual health services. [ABSTRACT FROM AUTHOR]

Objective: Although Hispanic adolescents in the USA are often the focus of sexual health interventions, their response to survey measures has rarely been assessed within evaluation studies. This study documents the test–retest reliability of a wide range of self-reported sexual health values, attitudes, knowledge and behaviours among Hispanic adolescents from low-income, urban communities. Method: Intraclass correlation coefficients were calculated for sexual health scales (knowledge, values about condom use, parent communication, protection self-efficacy and condom-use intentions) in a 2-week sample (N = 86). Cohen’s kappa and the intraclass correlation coefficients were calculated for behaviours (romantic and sexual behaviours, and sexual health services history) in two separate 2-week samples (N = 86, N = 202). Selected behaviours were also examined for retractions in both 2-week samples and in a 1-year sample (N = 291). Results: Among sexual health scales, test–retest reliability ranged from .37 for condom-use intentions to .93 for parent communication. Among behaviours, reliability ranged from 0.27 for use of sexual health services to 1.00 for use of birth control at first sex. Retractions ranged from below 10% for ever having had a steady partner to 50% or more for sexual health services and testing. Conclusion: Test–retest reliability differed greatly across self-reported sexual health values, attitudes, knowledge and behaviours for the three samples of Hispanic adolescents. Overall, however, most items and scales showed good to excellent reliability (i.e. a coefficient greater than .60), suggesting that Hispanic adolescents are moderately to highly stable reporters in response to sexual health measures. [ABSTRACT FROM AUTHOR]

Background: An emerging model for sexuality education is the rights-based approach, which unifies discussions of sexuality, gender norms, and sexual rights to promote the healthy sexual development of adolescents. A rigorous evaluation of a rights-based intervention for a broad population of adolescents in the U.S. has not previously been published. This paper evaluates the immediate effects of the Sexuality Education Initiative (SEI) on hypothesized psychosocial determinants of sexual behavior. Methods: A cluster-randomized trial was conducted with ninth-grade students at 10 high schools in Los Angeles. Classrooms at each school were randomized to receive either a rights-based curriculum or basic sex education (control) curriculum. Surveys were completed by 1,750 students (N = 934 intervention, N = 816 control) at pretest and immediate posttest. Multilevel regression models examined the short-term effects of the intervention on nine psychosocial outcomes, which were hypothesized to be mediators of students' sexual behaviors. Results: Compared with students who received the control curriculum, students receiving the rights-based curriculum demonstrated significantly greater knowledge about sexual health and sexual health services, more positive attitudes about sexual relationship rights, greater communication about sex and relationships with parents, and greater self-efficacy to manage risky situations at immediate posttest. There were no significant differences between the two groups for two outcomes, communication with sexual partners and intentions to use condoms. Conclusions: Participation in the rights-based classroom curriculum resulted in positive, statistically significant effects on seven of nine psychosocial outcomes, relative to a basic sex education curriculum. Longer-term effects on students' sexual behaviors will be tested in subsequent analyses. [ABSTRACT FROM AUTHOR]