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This study examined the psychosocial problems of a sample of adolescent women who presented for a pregnancy termination appointment at a family planning clinic located in the southeastern region of the United States. The sample consisted of 120 adolescent women, age 14-21 who were administered the Multidimensional Adolescent Assessment Scale (MAAS) while waiting for their pregnancy termination procedure. The MAAS is a self-administered instrument with multiple subscales that measure a variety of psychosocial problems. Results indicated that most subjects did not score in the clinical range on the various subscales, thus indicating respondents as overall being stable and healthy. This paper reviews the specific findings from the study and discusses implications for practice and future research directions on this understudied population. [ABSTRACT FROM AUTHOR]

Good quality patient care requires health care providers to respect the humanity and autonomy of their patients. However, this is not achieved in all settings. This study used cross-sectional survey data including open-ended text responses to explore negative experiences with health care providers among women in Appalachia. We used the Heath Stigma & Discrimination Framework (HSDF) to identify how stigma is created and perpetuated through interactions with health care providers. Survey data from 628 women collected through purposive sampling identified that two out of three participants had had a bad encounter with a provider that made them not want to return for care. One in six participants had a negative experience specifically while seeking contraception. Using the domains of the HSDF framework, qualitative answers to open-ended questions illuminated how health care providers, influenced by social and cultural norms related to religiosity, patriarchal views, poverty, poor health infrastructure, and the opioid crisis, created and perpetuated stigma through dehumanising treatment, low-quality care, and health care misogyny. Because stigma is a driver of health inequity, these findings highlight the important and sometimes problematic role that health care providers can play when they create a barrier to future care through poor treatment of patients.

Very little is known about contraceptive behavior in Appalachia, a large geographic region in the eastern United States where even basic prevalence estimates of contraceptive use/nonuse are lacking. This study characterizes contraceptive behavior among Appalachians, including contraceptive use, reasons for use, and methods used; contraceptive nonuse and reasons for nonuse; and attitudes about contraception, including acceptability. This is a secondary analysis of a subsample of survey data collected on sexual and reproductive health attitudes, behaviors, and needs among reproductive-age women (18-49 years) living in the Appalachian region ( n = 332). Results identify rates of contraceptive use (66.6%) and nonuse (33.1%) among Appalachian residents. Methods used most frequently included those that did not require prescription (i.e., external condoms and natural family planning methods) though many reported the use of intrauterine devices (IUDs). Among nonusers, fear of side effects from contraception and ambivalence towards pregnancy were most commonly selected as the most important reason for not using contraception. Contraception was considered acceptable by this sample overall, and these acceptability attitudes were significantly associated with contraceptive behavior.

Objective: To investigate the frequency and impact of contraceptive coercion in the Appalachian region of the United States., Data Sources and Study Setting: In fall 2019, we collected primary survey data with participants in the Appalachian region., Study Design: We conducted an online survey including patient-centered measures of contraceptive care and behavior., Data Collection/extraction Methods: We used social media advertisements to recruit Appalachians of reproductive age who were assigned female at birth (N = 622). After exploring the frequency of upward coercion (pressure to use contraception) and downward coercion (pressure not to use contraception), we ran chi-square and logistic regression analyses to explore the relationships between contraceptive coercion and preferred contraceptive use., Principal Findings: Approximately one in four (23%, n = 143) participants reported that they were not using their preferred contraceptive method. More than one-third of participants (37.0%, n = 230) reported ever experiencing coercion in their contraceptive care, with 15.8% reporting downward coercion and 29.6% reporting upward coercion. Chi-square tests indicated that downward (χ 2 (1) = 23.337, p < 0.001) and upward coercion (χ 2 (1) = 24.481, p < 0.001) were both associated with a decreased likelihood of using the preferred contraceptive method. These relationships remained significant when controlling for sociodemographic factors in a logistic regression model (downward coercion: Marginal effect = -0.169, p = 0.001; upward coercion: Marginal effect = -0.121, p = 0.002)., Conclusions: This study utilized novel person-centered measures to investigate contraceptive coercion in the Appalachian region. Findings highlight the negative impact of contraceptive coercion on patients' reproductive autonomy. Promoting contraceptive access, in Appalachia and beyond, requires comprehensive and unbiased contraceptive care., (© 2023 The Authors. Health Services Research published by Wiley Periodicals LLC on behalf of Health Research and Educational Trust.)

The reproductive autonomy of persons who can give birth can be impeded through forms of interpersonal violence and coercion. Moreover, macro-level factors (e.g., poverty, discrimination, community violence, legislative policies) may impede the reproductive autonomy of entire communities. This study investigates a form of violence we term perceived contraceptive pressure in Appalachia, an understudied region of the Eastern U.S., regarding reproductive health and decision-making. Through targeted Meta advertising, participants ( N  = 632) residing in Appalachian zip codes completed an online survey on reproductive health. The focus of this study was to investigate the prevalence of perceived contraceptive pressure, who was at increased risk of experiencing pressure, and the source(s) of perceived pressure. Binomial regressions were conducted on three different dependent variables: perceived pressure to be sterilized, perceived pressure to use birth control, and perceived pressure not to use birth control. Approximately half of all respondents (49.5%) reported experiencing at least one type of pressure targeting contraceptive decision-making. The most prevalent source of perceived pressure to use birth control was from the healthcare provider (67.4%), and the most prevalent source of perceived pressure not to use birth control was the respondent's partner (51.1%). Recommendations for providers serving clients in the Appalachian region include pursuing education regarding contraceptive pressure at the individual level and macro-level. In addition, Appalachian residents may benefit from educational programming on reproductive autonomy, healthy relationships, and how to navigate pressure in relationships.

Objective: The purpose of this study was to investigate the psychometric properties of the short-form Reproductive Coercion Scale among a sample of Appalachian women., Study Design: We recruited a purposive sample of Appalachian women, using targeted Facebook ads to collect data via an online survey in fall 2019. We randomly split our sample into two independent samples and used exploratory factor analysis on sample 1 (N = 314) and confirmatory factor analysis on sample 2 (N = 314) in order to cross-validate our findings., Results: Findings indicated that the short-form Reproductive Coercion Scale is a valid and reliable instrument to assess reproductive coercion among this sample of Appalachian women. Our findings indicated that, in this Appalachian sample, the reduced, five-item Reproductive Coercion Scale measured a unidimensional construct and was not comprised of the multiple dimensions of pregnancy coercion and condom manipulation. As expected, intimate partner violence and pregnancy fatalism were significantly and positively associated with reproductive coercion while religious affiliation and insurance status were not significantly associated with reproductive coercion. These findings help build construct validity for the short-form Reproductive Coercion Scale with this sample., Conclusion: While pregnancy coercion and condom manipulation are often considered independent reproductive coercion factors, the current study indicates that, in this Appalachian sample, the short-form Reproductive Coercion Scale measures a single latent reproductive coercion factor., Implications: While pregnancy coercion and condom manipulation are often considered independent reproductive coercion factors, the current study indicates that, in this Appalachian sample, the short-form Reproductive Coercion Scale measures a single latent reproductive coercion factor. Additional research may be needed to confirm the factor structure of the short-form Reproductive Coercion Scale across populations and geographic conditions., (Copyright © 2021. Published by Elsevier Inc.)

Background: Opioid use among reproductive-age women has greatly increased, resulting in high rates of opioid-exposed pregnancies, which are associated with negative outcomes, such as neonatal abstinence syndrome. Prevention of unintended pregnancy among opioid users is a critical pathway to reducing opioid-exposed pregnancies; however, little is known about pregnancy intention in this group. This article estimates the prevalence of unintended pregnancy among opioid-using women, thereby supporting efforts to develop interventions to reduce unintended pregnancy., Methods: A systematic literature search was conducted in PubMed, Web of Science, PsycINFO, and CINAHL, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses framework. Reference lists of articles were searched. Eligibility criteria included reported unintended pregnancy rates within a population of opioid-using women of reproductive age. The search was completed in July 2018 and updated in October 2019., Results: We identified 115 citations, screened 64 titles/abstracts, reviewed 31 full-text articles, and included 12 articles for this review. Rates of unintended pregnancy in opioid users were estimated in two ways, across the lifetime and for a current pregnancy, depending on study samples. Rates for both groups were high, with rates among currently pregnant opioid-using women (85%) compared with 45% among the general population., Conclusions and Implications: Unintended pregnancy rates in opioid-using women were strikingly high, indicating a critical need for intervention. Routine inclusion of pregnancy planning in opioid treatment care is indicated. Education regarding contraception and opioid treatment services is essential for nurses in these settings. Family planning and opioid treatment efforts can be optimized by care coordination, with focus on nurse training for screening and patient education., Competing Interests: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article., (Copyright © 2021 International Nurses Society on Addictions.)

Background: In 2015, Tennessee enacted a law requiring a 48-hour wait and two clinic visits to obtain an abortion., Methods: Using data from a Tennessee clinic in 2016, we explore whether abortion seekers from the most economically disadvantaged ZIP codes and those who lived farther from the clinic were less likely to return for the abortion procedure at the second visit., Results: Rates of non-return were 44%-91% higher among residents of neighborhoods in which ≥25% of the population was below federal poverty level, ≥25% of the female population was below federal poverty level, and median annual household income was &lt;$35,000. Mean clinic distance was also consistently greater among those who did not return., Conclusions: Residents of the most economically disadvantaged ZIP codes may be disproportionately burdened by Tennessee's waiting period law, rendering them less able to return for the abortion procedure than residents of less economically disadvantaged ZIP codes. Furthermore, greater clinic distance may also impede access under this law.

This article describes a secondary data analysis of a health data set representing the experiences of abortion fund service recipients (ASRs) who received financial assistance to help pay for unaffordable abortion costs. The authors analyzed 3,216 ASR cases from 2001 to 2015. Demographic characteristics, service utilization rates, and the personal hardships reported by the sample were assessed. The personal hardships of the Florida ASRs were compared with the hardships reported by ASRs who received assistance from a national fund. Results indicate that Florida ASRs are primarily people of color who are single, in their mid-20s, already parenting children, and receiving assistance in the second trimester of pregnancy. ASRs in this current study are experiencing multiple personal hardships while trying to access an abortion, including economic hardships (such as lack of insurance coverage and unemployment) and trauma (including rape and partner violence). When compared with the ASRs at the national level, these state-level ASRs reported higher rates of unemployment, partner violence, and rape, which suggests that the Florida ASRs face some more dire circumstances compared with ASRs at the national level. Repeal of policy that restricts public funding of abortion in Florida is recommended to improve access to abortion., (© 2020 National Association of Social Workers.)

This study describes a secondary data analysis of contraceptive use across the lifetime and within the six months prior to incarceration in a sample of 400 currently incarcerated women recruited from rural, Appalachian jails, who were using drugs prior to incarceration. Phase 1 (baseline) data from an NIH funded study were used to examine rates of contraceptive use, reasons for nonuse of condoms, and correlates of condom use. Results indicate that the majority (96.5%) of respondents reported lifetime use of contraceptives, and most (70.5%) had a history of using multiple methods, with male condoms, oral contraceptive pills, and contraceptive injections being the most commonly used methods. Almost 69% of respondents reported nonuse of contraceptives within the last six months, despite high rates of involvement in risky, intimate male partnerships prior to incarceration. Contraceptive use was found to be historically acceptable in this sample, in stark contrast to rates of use within the last six months prior to incarceration, suggesting that reproductive justice-informed, social work interventions to help improve current contraceptive use are warranted as a harm-reduction approach.

Purpose: From 2009 to 2019, more than 175,000 refugees were admitted into the United States from African countries. What is known about sexual and reproductive health in this population is focused on perinatal outcomes; beliefs and attitudes towards family planning and related behaviors, which can impact perinatal health, have not been explored. Understanding these beliefs and attitudes can guide future work with this population., Study Design: A cross-sectional, convenience survey of 100 community-dwelling African refugee women was conducted., Results: The following research questions guided analysis: What are African refugee women's family planning attitudes (pregnancy intention, desired timing, perceived fecundity)? What are African refugee women's family planning behaviors (use vs. non-use of methods, type of methods used)? and What socio-demographic factors and family planning attitudes are related to family panning behaviors (use or non-use of methods)? Almost 49% of participants reported ever using a method of family planning and 35% reported current use. Reasons for non-use included desire for more children (28.8%), infrequent intercourse (22.0%), and fear of side effects (16.9%). Nearly two thirds expressed a desire for a future pregnancy (63.4%), but the majority reported wanting to become pregnant in two or more years (25.7%) or "when God wants" (24.8%). No significant relationship was found between family planning method use and future pregnancy intention, desired timing of future pregnancy, perceived fecundity, marital status, religious affiliation, number of years in the US. Having had any formal schooling decreased the likelihood of using a family planning method., Implications for Practice and Research: Low family planning method use rates among African refugee women are not completely explained by desires for future pregnancy, perceived fecundity, marital status, or other sociodemographic factors. Concern for future fertility and fear of side effects were identified as potentially modifiable reasons appropriate for community based culturally congruent educational interventions on family planning use., (© 2020 Wiley Periodicals, Inc.)

Reproductive health disparities in the Appalachian region may be driven by barriers to healthcare access. However, the barriers specific to accessing family planning services in Appalachia have not yet been identified from the perspectives of Appalachian community members. Moreover, it is unclear how community members might perceive elevated levels of opioid use in the region to impact family planning practices. To fill this gap in knowledge, the current qualitative study explored community perspectives about family planning in Appalachia in the context of the opioid epidemic for the purpose of developing a survey instrument based on these responses. We conducted three video call focus group interviews with community stakeholders, those who live, work and are invested in Appalachia ( N = 16), and analyzed the responses using Levesque, Harris, and Russell's (2013) five pillars of healthcare access as a framework to categorize family planning practices and perceptions of service needs in the context of regional substance abuse: (1) approachability, (2) acceptability, (3) availability and accommodation, (4) affordability, and (5) appropriateness. Subthemes within each of these five categories were also identified. Our findings highlight stakeholder concerns around a lack of knowledge about and access to family planning services in Appalachia. Community members also expressed concern around the lack of availability of substance use treatment services, which may negatively impact family planning use and access in the region.

Women who use opiates and are involved in the criminal justice system in Appalachia may be prone to adverse health outcomes. In this study, we performed a latent class analysis of risk and protective factors on 400 drug-using women recruited from rural, Appalachian jails. A two-profile solution best fit the data. Both profiles evinced low levels of condom use, reproductive and physical health screens, and STD history. However, the primary substantive difference between the profiles was partner risk behavior: the higher risk class had main male partners with histories of injection drug use and incarceration. Results suggest that interventions need to be tailored to unique profiles of risk and protective factors, which should include taking partner risk into consideration.

Objective: To describe the construction of the scenarios and the development of the realistic simulation technique in health on safe administration of drugs for nursing professionals., Method: Report of experience developed from October 2017 to May 2018 involving the steps of training of the facilitators, construction of the scenarios, development of the realistic simulation with nursing staff of a teaching hospital in the southern region of Brazil. The best simulation practice guidelines used from the International Nursing Association for Clinical Simulation and Learning., Results: Four practice-based scenarios were constructed based on adverse events. The nurses educators trained the facilitators participating in all stages. There was concern about the fidelity of the scenarios, as well as the execution of the briefing and debriefing stages., Conclusions: The simulation allowed the reflection of the "way of doing" of the teams adjusting the process of preparation and administration of medicines to the institutional recommendations and, thus, promoting the safety of the process.

The purpose of the study was to examine the association between women's experience of two types (sexual and physical) of intimate partner violence (IPV) and number of previous abortions among a national sample of 4,586 abortion patients between the ages of 13 and above 38 years in the United States. Using data from the nationally representative Abortion Patients Survey 2008, χ 2 tests were conducted to examine the bivariate associations between all independent and dependent variables. Prevalence ratios were calculated to determine the association between IPV, physical and sexual, and number of abortions, controlling for whether the coconceiving partner knew about the pregnancy and the abortion, and demographic factors including age, education, income, poverty rate, race, and type of union. Results indicate that approximately 51% of the sample of women seeking abortion services had never gotten an abortion before. Reports of IPV were low among this sample-5.6% reported physical violence and 2.4% reported sexual violence, while 82.3% of the coconceiving partners knew about the abortion, and 87.1% knew about the pregnancy. Prevalence ratios revealed that physical violence was positively associated with number of abortions (PR = 1.31, p < .001), but sexual violence was negatively associated with number of abortions (PR = 0.74, p < .05) when all control variables were accounted for. Findings suggesting that physical and sexual violence are differentially associated with a history of multiple abortions were unexpected and suggest the need for additional research in this area. Implications for practice, policy, and directions for future research are discussed., (© 2018 Springer Publishing Company, LLC.)

This paper details results of a study examining administrative case data from 2010-2015 from abortion funds serving the USA and the Republic of Ireland, Northern Ireland and the Isle of Man. Driven by the available data, the researchers compared organisational characteristics, patient characteristics, procedural costs, patient resources and the ratio between patient resources and procedural costs. Independent t-tests were conducted to assess whether differences in characteristics, costs or resources were significant. The number of patients serviced by abortion funds across the two datasets increased yearly from 2010-2015. While patients in the USA had more resources, on average, to contribute to their abortion procedure, Irish, Northern Irish and Manx patients had the resources to pay for a greater percentage of their costs, on average, which was mainly attributable to the differences in gestational age of those helped by the different abortion funds. Patients across all nations were similar in terms of their marital status, average age and number of existing children. Patients across these countries face expensive procedures and a lack of resources that are bridged in part by abortion fund assistance.

The results of a study examining differences between U.S. adolescent and adult abortion fund service recipients are presented in this paper. Using existing case data from 2010 to 2015 from the National Network of Abortion Funds (N = 3,288), a secondary data analysis was conducted to determine whether or not the experiences of adolescent (n = 481) and adult abortion patients (n = 2,807) who received financial assistance to help pay for an abortion differed. Fisher's exact tests examined differences in dichotomous variables, and regression examined differences in procedural costs, patient resources and expected travel distances to obtain an abortion. Results show that a greater proportion of adolescents in this data set identified as African American, and that adolescents were more likely to report seeking an abortion due to lack of contraception, and rape, while adult patients were more likely to be seeking an abortion due to contraceptive failure and partner violence. Results are discussed using a trauma-informed framework., (© 2018 John Wiley & Sons Ltd.)

In this study the authors assessed the association between the types contraceptive use (unreliable or traditional methods vs. modern methods) and number of abortions among a nationally representative sample of abortion patients in the United States from the Abortion Patients Survey 2008. Unadjusted and adjusted prevalence ratios were calculated to determine the association between unreliable contraceptive methods and number of abortions. Results from the unadjusted and adjusted prevalence ratios revealed that women who used modern methods of contraception were more likely to have had previous abortions compared to women who did not use contraceptives and those who used traditional methods of contraception. Implications for practice, policy, and the role of social workers are discussed.

Researchers describe hardships experienced by abortion patients, examining administrative health cases from 2010 to 2015 in the United States. All patients received financial assistance from an abortion fund to help pay for abortion. Case data were analyzed to assess types and numbers of hardships experienced by age, race, and geographic origin. Hardships ranged from homelessness to parenting multiple children. Patients from the geographic South experienced the most hardships, followed by those from the Midwest. Hardships experienced by abortion fund patients are like those reported in other samples of abortion patients; hardships potentially cause or exacerbate trauma. Results are discussed in the context of a trauma-informed perspective.

Background: The purpose of the present study was to assess the association between microfinance and contraceptive use. A secondary purpose of the study was to assess the role of control over resources between microfinance participation and contraceptive use., Method: Using secondary data from Bangladesh Demographic and Health Survey 2011 the present study conducted logistic regression analysis to estimate the interaction effect of microfinance participation and control over resources on reported contraceptive use., Results: Findings indicate that microfinance participants are 1.69 times more likely to use contraceptive (P < 0.001), and women with control over resources are 4.28 times more likely to use contraceptive (P < 0.001). However, the interaction effect of microfinance participation and control over resources suggest that microfinance participants with control over resources are less likely to use contraceptive, but that finding is not significant., Conclusion: While control over resources matter the most in terms of women's use of contraceptive, this does not hold true for microfinance participants with control over resources., (© The Author 2016. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

The results of a secondary data analysis of 3,999 administrative cases from a national abortion fund, representing patients who received pledges for financial assistance to pay for an abortion from 2010 to 2015, are presented. Case data from the fund's national call center was analyzed to assess the impact of the fund and examine sample demographics which were compared to the demographics of national abortion patients. Procedure costs, patient resources, funding pledges, additional aid, and changes over time in financial pledges for second-trimester procedures were also examined. Results indicate that the fund sample differed from national abortion patients in that fund patients were primarily single, African American, and seeking funding for second trimester abortions. Patients were also seeking to fund expensive procedures, costing an average of over $2,000; patients were receiving over $1,000 per case in pledges and other aid; and funding pledges for second trimester procedures were increasing over time. Abortion funding assistance is essential for women who are not able to afford abortion costs, and it is particularly beneficial for patients of color and those who are younger and single. Repeal of policy banning public funding of abortion would help to eliminate financial barriers that impede abortion access.

Objectives: Our objective was to assess whether microfinance participation affords greater contraceptive decision-making power to women., Study Design: Population based secondary data analysis., Methods: In this cross-sectional study using nationally representative data from the Bangladesh Demographic and Health Survey 2011 we conducted multinomial logistic regression to estimate the odds of contraceptive decision-making by respondents and their husbands based on microfinance participation. Microfinance participation was measured as a dichotomous variable and contraceptive decision-making was conceptualized based on who made decisions about contraceptive use: respondents only; their partners or husbands only; or both., Results: The odds of decision-making by the respondent, with the reference case being joint decision-making, were higher for microfinance participants, but they were not significant. The odds of decision-making by the husband, with the reference case again being joint decision-making, were significantly lower among men who were partnered with women who participated in microfinance (RRR = 0.70, P < 0.01)., Conclusion: Microfinance participation by women allowed men to share decision-making power with their wives that resulted in higher odds of joint decision-making., (Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

This article examines the concept of being "easy" as a quality that female caregivers aspire to as they envision their potential care in later life. It draws on data from a qualitative study exploring the significance of caregiving to adult daughters' perspectives and plans for their own aging. Caregivers' experiences differ based upon their perception of how easy or difficult it was to care for their loved one. The former exemplifies a positive way to approach aging and the receiving of care. Being easy describes an attitude that these caregivers desired for their own later life.

This article describes a community-based Patient Navigation (PN) project conducted to identify potential barriers to seeking follow-up cervical cancer care in southeastern Kentucky. Patient navigators (PNs) were placed in cervical cancer programs within county public health departments where they interviewed patients about their perceived barriers to seeking follow-up care after receiving a positive Pap test result. Participants identified various potential barriers at three levels: the individual/personal level, the health care system level and the community/environmental level. One identified barrier that was unique to this study was a lack of consistency between follow-up recommendations and follow-up guidelines for patients under age 21. Implications are discussed.

The purpose of this article is to describe a pilot study of 16 Appalachian Kentucky school districts designed to gather information about their school vaccination and health education programs in relation to the Human Papillomavirus (HPV) vaccine. School district administrators were contacted by a professional telephone interviewer and asked to participate in a structured interview that also included open-ended questions. Results suggest that few schools have school-based vaccination programs, and of those that do, very few programs include the HPV vaccine. A majority of respondents reported that information leaflets about HPV are available in the schools, whereas few schools include discussions of HPV in their health programs. Almost all respondents reported an excellent relationship with their county health departments, school nurses, and school social workers, although most schools lacked the presence of a school social worker. Implications for social work practice and policy and directions for future research are also discussed.

The purpose of the current study was to examine social work student attitudes toward the social work profession's perspective on certain aspects of reproductive health in the United States: contraception, emergency contraception, and the Human Papillomavirus (HPV) vaccine. Students at a large, public, land grant university were surveyed to determine whether their personal attitudes were in line with the National Association of Social Workers (NASW) stance on reproductive health outlined in the NASW policy statement on family planning and reproductive health. The relationship between levels of religious activity and attitudes toward these aspects of reproductive health was also examined. Results suggest that almost all of the respondents support public funding for family planning. Furthermore, almost all students indicate willingness to refer clients for general contraception. However, results related to emergency contraception indicate that 72% of students disagree that it should be available for adolescents over the counter, even with parental consent, which is inconsistent with the NASW perspective. Sixty-four percent of students report believing that the HPV vaccine is unsafe. Further, as levels of religious activity increased, acceptance of some of these aspects of reproductive health decreased. Implications for social work practice, education, and directions for future research are discussed.

The purpose of this study was to examine the effectiveness of a community health worker (CHW)-delivered cancer education program designed to increase knowledge and awareness of colorectal cancer screening options. The study population was an extremely vulnerable and medically underserved geographic region in Appalachian Kentucky. CHWs enrolled participants in face-to-face visits, obtained informed consent, and administered a baseline assessment of knowledge of colorectal cancer risks and the benefits of screening and screening history. An educational intervention was then provided and participants were re-contacted 6 months later when a posttest was administered. The mean score of the 637 participants increased from 4.27 at baseline to 4.57 at follow-up (p < .001). Participants who reported asking their health care provider about colorectal cancer screening increased from 27.6% at baseline to 34.1% at follow-up (p = .013). Results suggest that CHWs were very effective at maintaining the study population; no loss to follow-up occurred. The results also showed increased knowledge and awareness about colorectal cancer screening education. Implications for social work practice, policy and research are discussed.

The purpose of this article is to describe an exploratory study examining the relationship between intimate partner violence and psychological stressors in a sample of 188 adult abortion patients. Results indicate the almost 15% of respondents report a history of abuse by the coconceiving partner. In addition, women who reported having had one or more past abortions were more likely to also report that the person involved in the current pregnancy had also emotionally abused them. Women reporting one type of partner abuse were significantly more likely to also report other types of abuse. Women reporting abuse were less likely to report informing their coconceiving partner of their appointment at the clinic, less likely to report that their partner contributed financially to the abortion cost, and more likely to report partner refusal to wear a condom. Women who reported emotional abuse were more likely to score higher on all but one of the psychological stressor scales. The implications of these findings are discussed.

This study compared perceived and objective health status among a population with elevated risk of chronic disease in rural, Appalachian Kentucky, in order to inform the practice efforts of public health social workers. Cross-sectional data were collected from a sample of 203 adults recruited through a mailed invitation. The participants ranged in age from 20 to 93 (M = 50.8, SD = 13.5), 115 (56.7%) and nearly all were Caucasian, reflecting the demographic composition of the population of the area. Although 75% of the study population was overweight or obese, over 60% perceived their health status as good, very good, or excellent. Less than half reported engaging in physical exercise, and only 25% reported eating at most one serving of fruits or vegetables in the past week. The results suggest clear discrepancies between perceived health status and objective indicators of health risks in the study sample. Public health social workers who provide health education and advocacy for this population will need to consider these discrepancies when developing practice approaches for individuals residing in this and other similar communities.

Background: The relationship between suicidal thinking and adolescent dating violence has not been previously explored in a sample of adolescent abortion patients., Aims: This paper highlights a study where the relationship between dating violence and severity of suicidal thinking was examined in a sample of 120 young women ages 14-21 seeking to terminate an unintended pregnancy., Methods: The Multidimensional Adolescent Assessment Scale and the Conflict in Adolescent Relationships Scale was used to gather information about psychosocial problems and dating violence so that the relationship between the two problems could be examined, while controlling for the other psychosocial problems., Results: The results suggest that dating violence was related to severity of suicidal thinking, and that the magnitude of this relationship was moderated by the severity of problems with aggression., Conclusions: Specifically, as the severity of participant's general problems with aggression increased, the magnitude of the relationship between dating violence and severity of suicidal thinking increased. Limitations of the study and implications for practice are discussed.

Fifty percent of female adolescents in the United States have intercourse by age 17, yet they do not have the autonomy under the law to access reproductive healthcare services that can address and prevent the negative consequences often associated with adolescent involvement in sexual activity. This article discusses disparities in access to reproductive health services for adolescents in three areas: abortion, over-the-counter emergency contraception, and the provision of the human papillomavirus vaccine. Suggestions for advocacy efforts necessary to eliminate such health disparities are also presented in an effort to elevate female adolescents to a status where they have the same access to health services that are available to adult women.

The relationship between dating violence and 13 psychosocial problems, conceptually organized into three symptom clusters--depressive, family problem, and posttraumatic stress--was investigated in a sample of adolescent pregnancy termination patients, ages 14 to 21. Results of a multivariate multiple-regression analysis indicated that, after controlling for age, ethnicity, general aggression problems, and problems with peers, dating violence was significantly related with the symptoms clusters. At the univariate level, the results suggested that dating violence was significantly related with self-esteem problems, guilt, and suicidal thinking from the depressive symptoms cluster and with guilt and stress from the posttraumatic stress cluster. The implications of these findings are discussed.