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Aims: To evaluate the impact of systematic reviews on research funded by the Agency for Healthcare Research and Quality (AHRQ) through Evidence-based Practice Centers (EPCs), and to identify barriers to and facilitators for the effects of these documents on future research. Methods & materials: Two AHRQ systematic reviews were selected as case studies to evaluate their impact on future research. Key citations generated by these reports were identified through ISI Web of Science and PubMed Central and traced forward to identify effects on subsequent studies through citation analysis from updated systematic reviews on the topics. Requests for applications and program announcements from the NIH Guide for Grants and Contracts website were reviewed and dissemination data were obtained from AHRQ. Finally, interviews were conducted with 13 key informants to help identify short-, medium- and long-term impacts of the EPC reviews. Results: The measurable impact of the two EPC reviews is demonstrably greater on short-term outcomes (greater awareness of the issues) than on medium-term (e.g., the generation of new knowledge) or long-term outcomes (e.g., changes in patient practice or health outcomes). Factors such as the topic and the timing of the report relative to the development of the field may explain the impact of these two AHRQ reports. The degree to which the new research can be directly attributed to the AHRQ reviews remains unclear. Key informants discussed several benefits stemming from the EPC reports, including providing a foundation for the research community on which to build, heightening awareness of the gaps in knowledge, increasing the quality of research and sparking new directions of research. However, the degree to which these reports were influential hinged on several factors including marketing efforts, the very nature of the reports and other influences external to the EPC domain. Conclusions: The findings outlined in this article illustrate the importance of numerous factors influencing future research: the breadth, specificity and readiness of the topic for more research, ongoing developments in the field, availability of funding and active engagement of champions. AHRQ and the EPCs may be able to improve the likelihood of impact by creating more targeted products, planning for and expanding dissemination activities, improving the readability and other attributes of the reports themselves, and actively involving funders early on and throughout the process of creating and publishing the reviews.

Federal Title IV-E Adoption Assistance is an essential resource for states moving children from foster care to adoption. Secondary analyses indicate that federal funds support nearly half the costs of all adoption subsidies. Due to variations in eligibility, federal matching rates, and states' use of the program, the proportion of total subsidy costs supported by Title IV-E funds ranges from 25 to 72 percent among states. Multivariate analyses of recent adoptions demonstrate the importance of Title IV-E utilization for adopted children and their families, in that Title IV-E-eligible children are more likely to receive subsidies and to receive larger subsidies, compared to children who are not Title IV-E eligible. Variations in Title IV-E utilization have potential impacts on children, adoptive families and state child welfare agencies.

Most children adopted from foster care in recent years received an adoption subsidy. However, little is known about factors associated with subsidy receipt and amount. Analyses of the Adoption and Foster Care Analysis and Reporting System (AFCARS) shows that national data obscure substantial state-level variation in the proportion of adopted children receiving subsidies and the median subsidy amount. Several characteristics of adopted children were associated with subsidy receipt and amount, including age, race and ethnicity, and special needs status. Subsidy receipt and amount also varied with adoptive families' characteristics, such as pre-adoptive relationship with the child, family structure, and maternal race and ethnicity.

Domains central to the effects of sexual relationships on the acceptability of a vaginal protection method were explored in 14 focus groups and 38 in-depth interviews with women and men recruited from a health department's sexually transmitted infections (STI) and family planning clinics. Findings indicate that acceptability depended on a couple's relationship type, classified as serious, casual, or "new." Potential barriers to communication about product use may be overcome through direct or indirect covert use, depending on relationship type. More men than women thought women should always tell their partners if they use microbicides, regardless of relationship type. Results indicate the importance of the relationship context in understanding the likely acceptability of using microbicides, and perhaps any method of STI/HIV protection.

To provide scientific data regarding the changes in cervical mucus within the first hours to days after Norplant implant insertion and to estimate when the cervical mucus is hostile enough to suggest a contraceptive effect.Multicenter, clinical descriptive study.Family planning clinics.Forty-two women who were between days 8 and 13 of their menstrual cycle and who had requested Norplant implants were admitted to the study.Cervical mucus and blood samples were obtained.Cervical mucus scores, sperm penetration distances, and serum levels of progesterone, estradiol, and levonorgestrel.The median cervical mucus score observed at baseline was 6 ("fair"), indicating that the mucus was already somewhat hostile before insertion of the Norplant implants. The median scores declined to 5 at 12 and 24 hours and continued to decrease through day 7 to 2 ("poor"), a score that is judged as hostile to sperm penetration. Overall, 73% of all subjects had a poor cervical mucus score by 3 days after insertion; at 7 days after insertion, 90% exhibited poor mucus and none had a good score. There was a substantial drop in the overall median distance traveled by the vanguard sperm after 12 hours for each cervical mucus score grouping. The distance traveled decreased rapidly between 12 and 24 hours to0.5 cm in subjects with fair and poor mucus, and by day 3, 91% of the subjects exhibited poor sperm penetration.On the basis of our findings, deterioration of the quality of the cervical mucus and sperm penetration is evident by 24 hours after insertion, although not to a level that would suggest adequate protection until 72 hours after insertion. Therefore, we are confident in recommending that backup methods of contraception (e.g, condoms) need not be used for more than 3 days after insertion, even when the implants are inserted close to ovulation. These findings provide policy makers, clinic managers, and clinicians with important information about how they can improve client access to Norplant implants.To provide clinicians with evidence as to when the cervical mucus is hostile enough in new Norplant implant acceptors to indicate a contraceptive effect, 42 women requesting Norplant from clinical sites in Santo Domingo, Dominican Republic, and Baltimore, Maryland (US), in 1994-95 were enrolled in a clinical descriptive study. At baseline, when all women were between days 8 and 13 of their menstrual cycle, the median cervical mucus score was 6 ("fair") out of a possible maximum of 12. This score declined to 5 at 12 and 24 hours and continued to decrease through day 7, when it reached 2--a level judged hostile to sperm penetration. Overall, 73% of women had a "poor" cervical mucus score by day 3 and 90% were in this category by day 7. There were substantial drops in the overall median distance travelled by the vanguard sperm and in the percentage of subjects demonstrating poor sperm penetration after 12 hours for each cervical mucus score grouping. 91% of women had poor sperm penetration by day 3 and 93% by day 7. These findings suggest that backup contraceptive protection for the entire cycle after Norplant insertion--a standard recommendation--is not necessary given the profound effect of levonorgestrel on cervical mucus shortly after insertion, even in the event of possible ovulation.

CONTEXT: Parents can be an important influence on their children's sexual behavior. However, relatively little research has focused on fathers’ roles in protecting children from sexual risk or on their discussions with children about sex. METHODS: Sixteen focus groups comprising 131 parents of children aged 10–12 were conducted in three U.S. cities in 2007. Separate groups were held for mothers and fathers, and for white, black, English-speaking Hispanic and Spanish-speaking Hispanic participants. Content analysis was used to identify core themes and patterns related to fathers’ communications with their children about sex. RESULTS: Fathers were highly invested in ensuring that their children are safe and successful in life. Although some had not talked to their children about sex, others had discussed it frequently and openly, and nearly all agreed that fathers’ perspectives are important for children to hear. Fathers reported being better suited to discussing some topics (e.g., male puberty, how young men think) than others (menstruation). Fathers also described other strategies that they use to guide their children's development, such as emphasizing future goals and monitoring children's activities and friends. Many fathers, especially Hispanic participants, reported being more protective of daughters than of sons, and some had particular difficulty talking with their daughters about sex. CONCLUSIONS: Research and interventions concerning parent-child communication about sex should not neglect the role of fathers. However, some fathers may need support to overcome barriers to effective communication, especially with their daughters.

CONTEXT:Although parent-child communication about sex can significantly affect children’s sexual behavior, many parents do not talk to their children about sex. Qualitative research can elucidate parents’ attitudes toward and experiences with communicating with their children about sex. METHODS:In 2007, 16 focus groups were conducted with 131 mothers and fathers of children aged 10–12 in three cities in different regions of the United States. Separate groups were conducted for mothers and fathers, and for black, white and Hispanic parents. Content analysis was used to identify core themes and patterns. RESULTS:Parents believed it is important to talk to their children about sex and believed that doing so can be effective, but many had not done so. Primary barriers were parents’ perception that their children are too young and not knowing how to talk to their children about the subject. Parents found it easiest to talk to their children about sex if they had a good parent-child relationship, took advantage of opportunities to talk and began having the discussions when their children were very young. Some differences were noted by parents’ race, ethnicity, gender and location. CONCLUSIONS:Interventions aimed at encouraging parents to talk to their children about sex should enhance parents’ understanding of the stages of children’s sexual development and focus on the parents of young children. In addition, interventions should support parents in a range of strategies that complement discussions about sex.