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Alcohol and tobacco use are interrelated. This study examined response to very low nicotine content (VLNC) and moderate nicotine content (MNC) cigarettes by problematic drinking. We utilized a double-blind, randomized, within-subjects crossover design of VLNC and MNC cigarettes in two groups of adult cigarette smokers: with at-risk drinking (ARD

Background Genetic screening and testing has only recently become an accessible assessment for genetic risk. Unfortunately, these technologies have been underutilized in minority populations despite their usefulness for predicting diseases like sickle cell disease (SCD), often found in African American and Black and Hispanic populations. We surveyed prenatal patients to understand current choices, beliefs and experiences surrounding genetic screening and testing, specifically for sickle cell disease. Methods In this cross-sectional survey, we collected information from 322 women during prenatal visits from July 2019 through May 2021. Responses to questions about pregnancy screening and testing practices were analyzed for trends to identify barriers to care and education about testing and screening for sickle cell disease. Patients were asked to rate whether they agree or disagree with statements regarding sickle cell health behaviors. We used χ2 tests to compare categorical variables by self-reported race. Binary logistic regression was used to determine the odds ratios and confidence intervals for each outcome. Results Women were a mean (SD) age of 33.3 (6.1). 42.9% of patients self-identified as White while 41.3 of patients self- identified as African American/Black. Screening questions were adjusted for differences in race, insurance, and education levels to show significant differences in responses between African Americans/Blacks and Whites for screening for SCD (p=0.047, OR 95% CI= 0.455 [0.210-0.989]) and plans to meet with genetic counselors (p=0.049, OR 95% CI = 0.299 [0.090-0.993]). Regarding sickle cell health behaviors, only the responses to the statements about if sickle cell is not in their family, then it is likely not in themselves or their children, and partners' opinions about genetic screening remained significant (p=0.011 and p=0.081, respectively). Conclusions Our findings suggest gaps in screening, testing, and educational efforts between African American/Black and White patients, as well as differences in opinions regarding pregnancy management with a family history or gestational diagnosis of sickle cell disease. Future research should focus on decreasing these healthcare gaps and improving education that address concerns about SCD for relevant populations.

After comparing results of three prenatal substance use screening tools with biochemical verification, two were found to have satisfactorily high sensitivity and the third had greater specificity., OBJECTIVE: To compare and evaluate the accuracy of three screening tools in identifying illicit drug use and prescription drug misuse among a diverse sample of pregnant women. METHODS: This prospective cross-sectional study enrolled a consecutive sample of 500 pregnant women, stratified by trimester, receiving care in two prenatal clinical settings in Baltimore, Maryland, from January 2017 to January 2018. All participants were administered three index tests: 4P's Plus, NIDA Quick Screen-ASSIST (Modified Alcohol, Smoking and Substance Involvement Screening Test), and the SURP-P (Substance Use Risk Profile-Pregnancy) scale, and administered reference tests (urine and hair drug testing) at the in-person baseline visit. To assess test–retest reliability of the index tests, screening tool administrations were repeated 1 week later by telephone. For each screening tool, sensitivity, specificity, positive predictive value, negative predictive value and test–retest reliability were computed. Results were stratified by age, race, and trimester of pregnancy. RESULTS: Of the 500 enrolled pregnant women, 494 completed the index screening tools, 497 completed reference testing, and 453 underwent test–retest analysis. For the 4P's Plus, sensitivity=90.2% (84.5, 93.8), and specificity=29.6% (24.4, 35.2). For the NIDA Quick Screen-ASSIST, sensitivity=79.7% (71.2, 84.2), and specificity=82.8% (78.1, 87.1). For the SURP-P, sensitivity=92.4% (87.6, 95.8) and specificity=21.8% (17.4, 27.2). Test–retest reliability (phi correlation coefficients) was 0.84, 0.77, and 0.79 for the 4P's Plus, NIDA Quick Screen-ASSIST and the SURP-P, respectively. For all screening tools, there were differences in validity indices by age and race, but no differences by trimester. CONCLUSION: The SURP-P and 4P's Plus had high sensitivity and negative predictive values, making them more ideal screening tests than the NIDA Quick Screen-ASSIST. A clear recommendation for a clinically useful screening tool for prenatal substance use is crucial to allow for prompt and appropriate follow-up and intervention.

Objective: The objectives of this review were to summarize existing data on racial disparities in maternal immunization for influenza in the U.S. and to review the literature on interventions to improve the uptake of the influenza vaccine among Black pregnant women. Data Sources: U.S. survey data on maternal influenza immunization by racial and ethnic group were summarized in narrative form. To review intervention studies, PubMed, CINAHL, EMBASE, and the Cochrane Library databases were searched for English language articles published 2017 to 2021, in addition to studies identified by a previous systematic review. Study Eligibility Criteria: Peer-reviewed studies conducted in the U.S. and reporting interventions designed to increase the uptake of the influenza vaccine in pregnancy with study populations including at least 20% of participants identifying as Black were included. Study Appraisal and Synthesis Methods: Studies were grouped and reviewed in a narrative manner according to whether they were conducted in predominantly Black populations or in more racially diverse populations, and whether they tested multicomponent or single-component interventions. Results: A decade of survey data show that Black women in the U.S. consistently have the lowest rate of influenza immunization in pregnancy. Black women report a lower rate of being recommended or offered the vaccine, and provider recommendation is associated with greater vaccine uptake. Intervention studies to increase influenza immunization among Black pregnant women have reported mixed results. Successful interventions include multicomponent practice-based interventions, group prenatal care, and culturally competent patient educational messages. Conclusions: Racial disparities in maternal uptake of the influenza vaccine are long-standing, but not intractable. More research is needed to test interventions to address this disparity, with a focus on increasing provider recommendation and offer of the vaccine, addressing patients’ concerns about vaccine safety and efficacy, improving providers’ cultural competence, and building trust between providers and patients.

OBJECTIVE: There is a need to identify an acceptable and comprehensive substance use screening tool for pregnant women in the United States. This qualitative study sought to better understand prenatal practice staff perceptions of three existing substance use screening tools for use among pregnant women in an outpatient practice setting. METHODS: Eight focus groups with 40 total participants were conducted with clinical and administrative staff of two diverse Maryland prenatal practices in order to determine the acceptability and usability of three substance use screening tools (4P’s Plus, NIDA-Modified Alcohol, Smoking and Substance Involvement Screening Test, and the Substance Use Risk Profile-Pregnancy scale).. The focus groups were digitally recorded, transcribed, coded, and analyzed using thematic analysis. RESULTS: Participant perceptions of screening tools were dependent upon screening tool length, tone, comprehensiveness, subjectivity, time frame of questions, and scoring and clinician instructions. Most participants preferred the 4P’s Plus screening tool because it is brief, comprehensive, easy for the patient to understand, and excludes judgmental language and subjective questions. CONCLUSIONS: These results provide valuable insight into the specific needs and preferences of prenatal practice staff as it relates to prenatal substance use screening and provides evidence that the 4P’s Plus may be a preferred screening tool for standardized use in prenatal care.

OBJECTIVES: Substance use during pregnancy is a significant public health issue. Prenatal substance use increased in the past decade while prenatal cigarette smoking has remained stable. Co-use of tobacco and other drugs is a concern because of potential additive risks. This study aims to describe the prevalence rates of substance use among pregnant women and examine the association between smoking status (nonsmoker, recent quitter and current smoker) and other drug use. METHODS: In this cross-sectional study, pregnant women (n = 500) were recruited from two obstetric practices to complete three substance use screeners and have their urine tested for 12 different drug classes, including cannabis, opioids and cocaine. Participants were divided into three groups based on survey responses: nonsmokers, recent quitters (smoked in the month prior to pregnancy but not past month) and current smokers (past-month). RESULTS: Approximately 29% of participants reported smoking in the month before pregnancy. During pregnancy, 17, 12 and 71% were current smokers, recent quitters and nonsmokers respectively. Overall prevalence of illicit or prescription drug use in pregnancy was 27%. Cannabis was the most common drug used in pregnancy with prevalence of 22%, followed by opioids (4%), cocaine (1%), tricyclic antidepressants (TCAs) (1%), amphetamines (1%), and benzodiazepines (1%). On multivariable logistic regression, smoking in pregnancy was associated with a positive urine drug screen; with adjusted odds ratio (aOR) 4.7 (95% CI 2.6–8.3) for current smokers and 1.6 (95% CI 0.8–3.3) for recent quitters. Factors negatively associated with positive drug screen were second and third trimester pregnancies, 0.5 (0.3–0.9) and 0.3 (0.2–0.6) respectively; and employment, 0.5 (0.3–0.8). CONCLUSIONS FOR PRACTICE: Co-use of tobacco and illicit drugs, particularly cannabis, is relatively high during pregnancy. Additional research is needed to understand the health implications of co-use versus use of tobacco only. Given the strong association between smoking and other drug use, clinicians should routinely assess for illicit drug use in women who smoke during pregnancy.

OBJECTIVES: To pilot-test a Phone-based Postpartum Continuing Care (PPCC) protocol developed from existing evidence-based approaches to address both postpartum smoking relapse among low-income women who quit smoking during pregnancy and postpartum smoking increase among those who had cut down. METHODS: One hundred thirty low-income pregnant women who were current or recently quit tobacco smokers were recruited at their first prenatal appointment and randomized to either a Control (standard care) or Experimental (standard care + PPCC) group. An intent-to-treat analysis was conducted on biochemically-verified data from 6 in-person interviews during pregnancy and postpartum. Feasibility with regard to recruitment, randomization, assessment, and implementation of PPCC were assessed, along with acceptability among the target population. RESULTS: PPCC was found to be feasible and acceptable to some participants but not all. There were no significant differences in tobacco products per day at 6 months postpartum between groups; however, effect sizes differed at 6 weeks compared with 6 months postpartum. Similarly, there were no significant differences between groups in cessation rate (24% in each group) and past 90-day tobacco use (59 days vs 55 days, for Control and Experimental groups respectively). CONCLUSIONS: The PPCC intervention did not differentially reduce tobacco use postpartum compared with a controlled comparison group, though it was found to be acceptable among a subpopulation of low-income pregnant women and feasible with regard to recruitment, randomization, assessment procedures, and implementation. Further research is needed to identify an intervention that significantly improves smoking relapse rates postpartum.

Objectives. To assess trends in prevalence of cigar and blunt use in relation to cigarette use among pregnant and nonpregnant women of reproductive age. Methods. We used 2006 to 2016 data from the US National Survey on Drug Use and Health to assess past-month use of cigarettes, cigars, and blunts among a total of 8695 pregnant women and 162 451 nonpregnant women aged 18 to 44 years. Results. Cigarette use was more prevalent than cigar or blunt use in pregnant and nonpregnant women, with higher prevalence in nonpregnant women for each product. Among all women, cigarette use decreased and blunt use increased over time, whereas cigar use remained stable. Smoking prevalence was highest in the first trimester. Conclusions. The health implications of the increase in blunt use are not well known in the scientific literature or by the general public. Given the rapid changes in state marijuana laws, this issue should be a public health priority.

Background The use, misuse and co-use of alcohol, cannabis, tobacco, and other licit and illicit controlled substances has increased in past decades leading to higher rates of morbidity, overdose, and mortality in women of reproductive age. Co-use compounds the adverse health effects of substance use compared to single-use of similar substances. Little is known about the full range of substance combinations used by pregnant and non-pregnant women. We sought to describe patterns of co-use of alcohol, tobacco, and controlled substances, and examine correlates of co-use in a nationally-representative sample of women. Methods Cross-sectional study using self-reported survey data from 2006 to 2014 for women ages 18–49 years (N = 160,371) in National Survey on Drug Use and Health data. We use weighted proportions and 95% confidence intervals (CI) to report differences in substance use patterns in pregnant and non-pregnant women. Multivariate logistic regression models assessed association between characteristics and type of substance use pattern. Results Prevalence of substance co-use among pregnant women is 5.1% and among non-pregnant women is 23.6%. Nearly all of the most frequent co-use patterns included alcohol, cannabis, or tobacco. Determinants of co-use among pregnant women included: younger age (18–25 years) compared to ≥ 26 years [AOR (95% CI): 1.81 (1.18, 2.80)]; and past year history of substance use [AOR 5.42 (3.59, 8.20)]. Conclusions Co-use of several substances, including and especially of tobacco, alcohol and cannabis, persists among pregnant women in the United States. Efforts that aim to improve maternal and child health should address the complexity of substance use during pregnancy, including and beyond opioids.

The legalization of medical and recreational cannabis use has occurred ahead of science. The current evidence base has poor utility for determining if cannabis products can meet the standards of safety, efficacy, and quality intrinsic to modern medicine, and for informing regulation of cannabis as a legal intoxicant. Individual jurisdictions that pass cannabis reforms may not have adequate resources to support the level of new scientific research needed to inform regulatory actions; this could make it difficult to keep a rapidly growing multi-billion-dollar cannabis industry in check. Further, the present lack of evidence-based regulatory oversight for cannabis parallels the climates that gave rise to the tobacco and prescription opioid epidemics, suggesting that continued omission may result in negative public health consequences. However, translating a methodological framework developed through research on these compounds may promote rapid advances in cannabis science germane to regulatory knowledge gaps. The present review highlights specific advancements in these areas, as well as in alcohol regulation, that are prime for informing policy-relevant cannabis science, and also offers some recommendations for evidence-based regulatory policy. Resulting progress may directly inform both regulation of cannabis in both medical and licit recreational drug frameworks, and new cannabis-related public health initiatives.

Use of Cannabis and use of tobacco overlap, and co-use of Cannabis and tobacco has increased over the past decade among adults. The current study aims to document the prevalence and correlates of co-use of Cannabis and tobacco cigarettes among adult pregnant women utilizing secondary data from a larger study that compared and validated screeners for illicit and prescription drug use during pregnancy. Pregnant women (N = 500; 71% African American; 65% never married, average age of 28 years) were recruited from two urban University obstetric clinics between January and December 2017. Participants self-reported demographic, Cannabis, and tobacco cigarette use characteristics, and provided urine and hair samples for drug testing. Within two weeks after due date, research staff reviewed participants' electronic medical records to collect birth outcome data. Results showed that 9.0% reported co-use of Cannabis and tobacco, 12.1% reported Cannabis only use, 7.8% reported tobacco cigarette only use, and 71.1% reported no Cannabis or tobacco cigarette use in the past month. The birth outcomes to emerge as significant correlates of co-use of Cannabis and tobacco cigarettes were small head circumference, and the occurrence of birth defects, with the co-use group having the highest odds of a small head circumference [aOR: 5.7 (1.1–28.9)] and birth defects [aOR: 3.1 (1.2–8.3)] compared with other use groups. The Cannabis only group had 12 times higher odds of a stillbirth or miscarriage (aOR = 12.1). Screening and interventions to address concurrent Cannabis and tobacco use during pregnancy are needed, particularly among subpopulations with higher co-use rates. It is imperative to further explore and highlight the possible health implications of maternal co-use given the high prevalence rates found in this study sample.

This chapter examines the nature, patterns, outcomes and treatments for the most commonly used substances in pregnancy in Australia and the United States (US); tobacco, alcohol, marijuana, opioids and methamphetamine. Women who are substance dependent and pregnant need to be treated in a respectful and non-judgemental manner, as emphasised here by Emma: Issues of child protection are, however, paramount. In the US, there remains one state that criminalises drug use during pregnancy; 18 states consider substance abuse during pregnancy to be child abuse under civil child-welfare statutes; and three states consider it grounds for civil commitment. All health services for pregnant women who are substance dependent should be non-judgemental and provided in a holistic framework that is centred around the woman's current priorities and needs, and grounded in evidence based policies and procedures. The chapter concludes with the implications of substance use in the perinatal period for clinical practice.

In the United States, the number of incarcerated women continues to rise each year, with African American women having the highest incarceration rates. Many women enter prisons and jails with an extensive trauma history, though little is known about the percentage of these individuals suffering from posttraumatic stress disorder (PTSD) and specific trauma exposures they have had based on factors such as homelessness, degree of substance problems, and race. The present study examines a largely African American substance-using population of incarcerated women to determine the impact of various factors on specific traumas reported. We found that individuals reporting symptoms meeting criteria for PTSD had experienced the highest average number of traumas, and those who had ever been homeless also experienced many and varied trauma exposures compared with those who had never been homeless. Higher substance problems were also associated with more trauma exposure. Fewer than 10 percent of the sample met full cr...

Background Marijuana and tobacco are the most commonly used illicit and licit drugs during pregnancy. This study aimed to examine a nationally representative sample of US pregnant women and to: (1) determine the prevalence of past month marijuana and tobacco co-use, (2) identify characteristics that distinguish marijuana and tobacco co-users from users of marijuana only, tobacco only, or neither, and (3) compare characteristics that differ between pregnant and non-pregnant co-users of marijuana and tobacco. Methods Data were obtained from 497,218 US women (8721 pregnant) ages 12–49 who participated in the 2005–2014 National Survey on Drug Use and Health. Prevalence and demographic and substance use characteristics were compared across groups using weighted estimates and chi-squared tests. Multinomial logistic regression identified demographic and substance use correlates of co-use. Results Co-use among pregnant and non-pregnant women was significantly more prevalent than marijuana-only use but was less common than tobacco-only use. In unadjusted frequencies, pregnant co-users significantly differed from non-pregnant co-users across several domains. Among pregnant women, multivariate correlates of co-use of tobacco and marijuana vs. tobacco-only use were ages 12–17, non-Hispanic black race, Hispanic ethnicity, and past month polytobacco, any alcohol, and other drug use (all adjusted odds ratios ≥ 2.0). Conclusions In this first examination of the prevalence and correlates of co-use of marijuana and tobacco among a nationally representative group of pregnant women, pregnant co-users were more likely to report other high risk behaviors compared with non-pregnant co-users and users of a single substance, suggesting disparities worthy of further investigation.

This study conducts a within-subject comparison of the Addiction Severity Index (ASI) and the Global Appraisal of Individual Needs (GAIN) to assess change in alcohol and other drug treatment outcomes for pregnant and postpartum women. Data are from 139 women who were pregnant or who had children under 11 months old and were admitted to residential drug treatment, then re-interviewed 6 months postdischarge (83% follow-up rate). The ASI and GAIN change measures were compared on their ability to detect changes in alcohol and drug use, medical and HIV risk issues, employment issues, legal problems, family and recovery environment characteristics, and psychological/emotional issues. The measures were similar in their ability to detect treatment outcomes, and ASI and GAIN change scores were moderately correlated with each other. The GAIN scales had equal or slightly higher coefficient alpha values than the ASI composite scores. The GAIN also includes an HIV risk scale, which is particularly important for pregnant and postpartum women. These results suggest that the GAIN is comparable with the ASI and can be used for treatment research with pregnant and postpartum women.

Objectives To compare pregnant women who are current smokers at their first prenatal visit with those who recently quit smoking in the 90 days prior to their first prenatal visit (i.e., spontaneous quitters) to identify differences between them and factors that predict their intake smoking status. Methods One hundred and thirty participants were enrolled in this cross-sectional research study. The sample was drawn from a population of pregnant women attending their first prenatal visit at a low-income obstetrics clinic in Baltimore, Maryland; the large majority of which have characteristics that previous research has identified as putting them at high-risk of continued smoking during pregnancy. Participants were recruited through referrals from clinical staff. Intake data collection occurred between March and December, 2013. Results Of the 130 pregnant women enrolled in the study, 126 had complete intake data. The sample included 86 current smokers and 40 recent quitters. The large majority of participants were African American with an average age of 26. Current smokers were significantly more likely than recent quitters to have: more depression symptoms; self-perceived stress; internalizing and externalizing disorder symptoms; substance use disorders; and tobacco dependence. The most significant predictors of smoking status at first prenatal visit were depressive symptoms, readiness to quit, and number of children. Conclusions for Practice Differences were identified at intake among this sample of pregnant women already considered to be at high-risk for continued smoking throughout their pregnancy. This study identified relevant factors associated with whether or not a woman had recently quit smoking in early pregnancy or was continuing to smoke at her first prenatal visit. Knowledge of these factors may benefit physicians in understanding and promoting smoking cessation throughout the perinatal period and specifically intervening to decrease depressive symptoms and increasing readiness to quit may improve outcomes.

Substance use in pregnancy can have adverse effects on mother and fetus alike. Australia and the US are countries with high levels of substance use and policies advising abstinence, although the Australian approach occurs within a broader framework of harm minimization. Less attention has been paid to treatment of the mothers' substance use and what is considered gold standard. This is despite evidence that prior substance use in pregnancy is the most important factor in predicting future substance use in pregnancy. This paper draws together information from both the peer-reviewed and gray literature to provide a contemporary overview of patterns and outcomes of the three main drugs, alcohol, tobacco, and cannabis, used in Australia and the US during pregnancy and discusses what are considered gold standard screening and treatment approaches for these substances. This paper does not set out to be a comprehensive review of the area but rather aims to provide a concise summary of current guidelines for policy makers and practitioners who provide treatment for women who use substances in pregnancy.

The purpose of this study is to examine the prevalence of physical and psychological dating violence victimization and perpetration reported by inner-city African American and Hispanic adolescent girls as well as associated risky sexual behaviors among this population. Participants in this study were 10th- and 11th-grade female students from seven inner-city Chicago public high schools. Participants were administered with the Safe Dates measures of physical violence victimization, physical violence perpetration, psychological abuse victimization, and psychological perpetration. Approximately half of the sample reported some psychological dating violence victimization and perpetration, and approximately one third reported some physical victimization and perpetration. Hispanic adolescents were significantly more likely to report psychological victimization, whereas African American adolescents were significantly more likely to report physical dating violence perpetration. Victimization was found to predict perpetration in this population, and adolescents who acknowledged being both victims and perpetrators of dating violence were more likely to report having had vaginal sex and a higher number of past-year sexual partners. Inner-city African American and Hispanic adolescent girls may be particularly vulnerable to dating violence victimization and perpetration, which may be due to a number of other social factors not explored within this study. Furthermore, African American adolescent girls continue to engage in behaviors that increase their risk for negative health outcomes, predominantly STIs, highlighting the need for effective interventions with this population.

IntroductionPrescription-drug use in the USA has increased by more than 60% in the last three decades. Prevalence of prescription-drug use among pregnant women is currently estimated around 50%. Prevalence of illicit drug use in the USA is 14.6% among pregnant adolescents, 8.6% among pregnant young adults and 3.2% among pregnant adults. The first step in identifying problematic drug use during pregnancy is screening; however, no specific substance-use screener has been universally recommended for use with pregnant women to identify illicit or prescription-drug use. This study compares and validates three existing substance-use screeners for pregnancy—4 P’s Plus, National Institute on Drug Abuse (NIDA) Quick Screen/Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) and the Substance Use Risk Profile-Pregnancy (SURP-P) scale.Methods and analysisThis is a cross-sectional study designed to evaluate the sensitivity, specificity and usability of existing substance-use screeners. Recruitment occurs at two obstetrics clinics in Baltimore, Maryland, USA. We are recruiting 500 participants to complete a demographic questionnaire, NIDA Quick Screen/ASSIST, 4 P’s Plus and SURP-P (ordered randomly) during their regularly scheduled prenatal appointment, then again 1 week later by telephone. Participants consent to multidrug urine testing, hair drug testing and allowing access to prescription drug and birth outcome data from electronic medical records. For each screener, reliability and validity will be assessed. Test–retest reliability analysis will be conducted by examining the results of repeated screener administrations within 1 week of original screener administrations for consistency via correlation analysis. Furthermore, we will assess if there are differences in the validity of each screener by age, race and trimester.Ethics and disseminationThis study is approved by the Institutional Review Board of the University of Maryland (HP-00072042), Baltimore, and Battelle Memorial Institute (0619–100106433). All participants are required to give their informed consent prior to any study procedure.

Telephone continuing care (TCC) was compared to usual continuing care (UCC) on substance use and related problems among adults discharged from residential treatment. Participants were randomly assigned to receive either UCC or TCC. A tapered TCC protocol, initiated by paraprofessional staff and volunteers, was provided during the first three months following discharge. The TCC condition participants reported high satisfaction ratings with the procedure and were more than twice as likely to enter continuing care than UCC participants. At the three-month point, TCC patients reported significantly fewer past month substance problems than UCC patients. Among the subgroup of lower severity (LS) participants, the TCC-LS sample had both significantly more days abstinent and fewer past month substance problems at three months than the UCC-LS sample. The significant between-group differences in substance use outcomes were not maintained at the six-month follow-up. The high satisfaction ratings and early, favorable response among TCC patients suggest the procedure is promising. Further research with larger samples and over a longer period of time is necessary.

In the past 25 years, human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) have become leading causes of illness and death in the United States. Over 1 million people are living with HIV/AIDS in this country, yet there continue to be many individuals who are unaware of their HIV status. Efforts have been made by the Centers for Disease Control and Prevention to increase awareness by recommending universal testing in healthcare setting for all individuals ages 13-64, for both public health and personal health reasons. As women are one of the fastest-growing segments of the population with new HIV diagnoses, obstetrician-gynecologists are in a unique position to address this issue by recommending HIV testing to both pregnant and nonpregnant women. In this article, we compare the results of two recent studies conducted by the American College of Obstetricians and Gynecologists-one which examined obstetrician-gynecologists' practice patterns related to HIV testing and recommendations and the other which assessed patients' perceptions of HIV testing and recommendations by their obstetrician-gynecologists. The results of this comparison raise intriguing questions about the similarities and differences between what obstetrician-gynecologists report doing and what their patients perceive them doing as it relates to HIV testing recommendations.

Objectives The objectives of this study were to (1) determine the percentage of obstetrician-gynecologists' patients who have been tested for HIV; (2) examine patient attitudes about HIV testing and patients' knowledge about their own risk status; (3) determine primary reasons patients decline an HIV test; and (4) learn patient recall of how their obstetrician-gynecologists approach the topic of HIV testing. Method Survey packets were mailed to each of 687 obstetrician-gynecologists who are members of the Collaborative Ambulatory Research Network (CARN) to distribute to their patients. Data are reported from 851 patient respondents (297 pregnant and 554 non-pregnant), and were analyzed utilizing independent samples t-tests, v 2 analysis, and linear regression. Results Two-thirds of respondents (65%/n = 534) reported having been tested for HIV at some point, although the majority (72%) did not recall that their current obstetrician-gynecologist had rec- ommended HIV testing. Among pregnant respondents specifically, 61% did not recall that their current obstetri- cian-gynecologist had recommended HIV testing, although 82% reported having had an HIV test at some point and 71% stated they had received their most recent HIV test results from their obstetrician-gynecologist during their current pregnancy. Age, race, and pregnancy status were linked to likelihood of patient recall of receiving an HIV testing recommendation from their obstetrician-gynecolo- gist; with young, pregnant, Hispanic, and African- American patients most likely to recall a test recommen- dation. Perceived low risk was the primary reason given for declining an HIV test. Only 2% of respondents considered themselves high-risk for HIV despite almost half of the sample reporting having had unprotected sex at some point with more than one partner. Conclusions Many patients did not recall that their obstetrician-gynecologist had ever recommended HIV testing, although the majority had been tested. Efforts should be made to increase communication between obstetrician-gynecologists and their patients rela- ted to HIV risk status and HIV testing.

To assess obstetrician-gynecologists' perceptions of their residency training in primary care, document health issues assessed at annual visits, and identify practice patterns of both generalist and specialist obstetrician-gynecologists.Questionnaires were mailed to a random sample of 1,711 American College of Obstetricians and Gynecologists Young Fellows in September 2005. Information was gathered on perceptions about adequacy of residency training, how well training prepared obstetrician-gynecologists for current practice, and typical practice patterns for various medical diagnoses. Data were analyzed using univariate analysis of variance, t tests, and chi-square tests.Of 935 respondents (55% response rate), physicians estimated that 37% of private, nonpregnant patients rely on them for routine primary care. Approximately 22% report that they needed additional primary care training, specifically for metabolism/nutrition and dermatologic, cardiovascular, and psychosexual disorders. A wide range of topics, except for immunizations, were typically discussed at annual visits. Patients with pulmonary diseases, vascular diseases, and nongenital cancers were most often referred to specialists, whereas patients with urinary tract infections, sexually transmitted infections, or who are menopausal are most often managed totally. Self-identification as a generalist or specialist was associated with some practice patterns. Respondents were neutral about the role of primary care in obstetrics-gynecology residency training.For several primary care issues, obstetrician-gynecologists assumed sole management for obstetric patients but deferred to a primary care physician for gynecological patients. There is a continuing need for primary care training in obstetrics-gynecology residency, although it is unclear whether current training is adequate to meet their needs.

To examine obstetrician-gynecologists' knowledge, opinions, and practice patterns related to cesarean delivery on maternal request.Questionnaires were mailed to 1,031 American College of Obstetricians and Gynecologists Fellows in February 2006, with a response rate of 68%. The questionnaire queried respondents' demographic characteristics, practices and attitudes surrounding vaginal and cesarean deliveries, knowledge and beliefs regarding the risks and benefits of elective and nonelective cesarean delivery, and counseling practices and department policies for cesarean delivery on maternal request.About half of respondents believe women have the right to cesarean delivery on maternal request, and a similar percentage acknowledge having performed at least one cesarean delivery on maternal request. Fifty-eight percent of respondents note an increase in patient inquiries regarding cesarean delivery over the past year, yet most of their practices do not have a policy regarding this procedure. Respondents attribute the increase in inquiries to the increase of information from the media and to convenience. Respondents cited more risks than benefits of cesarean delivery on maternal request, and nearly all discuss these risks with patients who are considering one. Females were more negative toward cesarean delivery on maternal request than males and endorsed more risks and fewer benefits. There were no relationships between assessment of risks and benefits or practice with clinician age or patient characteristics.Most obstetrician-gynecologists in this study recognized an increased demand for cesarean delivery on maternal request within their practices, while believing that the risks of this procedure outweigh the benefits. Clinicians would benefit from strong evidence regarding risks and benefits, evidence that is crucial to guiding policy making with regard to cesarean delivery on maternal request.III.

OBJECTIVE Electronic cigarettes (e-cigarettes) are a relatively recent phenomenon, serving dual roles as an alternative vehicle for nicotine delivery and a smoking-cessation tool. The purpose of this study was to determine pregnant women's knowledge, attitudes, and practice regarding electronic cigarettes. STUDY DESIGN A voluntary, anonymous survey was distributed to a convenience sample of pregnant women presenting to a university-based outpatient clinic. After survey completion, participants received information about smoking cessation and e-cigarettes. Data were examined using χ² and Fisher exact tests and analysis of variance. Stata was used for the analysis. RESULTS Of the 326 surveys distributed, 316 were completed (97%). Of the 316 participants, 42 (13%) reported having ever used e-cigarettes. Only 2 (0.6%) reported current daily use. Ever users were slightly older (27.3 years vs 25.4 years; P = 0.007) and more likely to be current smokers (43% vs. 14%; P < 0.001) compared with women who had never used electronic cigarettes. Knowledge of the harms of smoking was similar between the 2 groups. Overall, 57% of all respondents believed that e-cigarettes contain nicotine, 61% that e-cigarettes can be addictive, and 43% that e-cigarettes are less harmful to a fetus than traditional cigarettes. Among ever users, the most common reasons given for the use of e-cigarettes were the perception of less harm than traditional cigarettes (74%) and help with smoking cessation (72%). CONCLUSIONS Misconceptions about e-cigarettes are common among pregnant women, potentially motivating use that may pose risks to both maternal and child health. Screening and education regarding e-cigarettes should be included in prenatal care. Future research in this area is necessary, including research examining pregnancy outcomes among women who use e-cigarettes.

UNLABELLED: In recent years, obstetrician-gynecologists have taken on a greater role in the provision of primary care. Mental health has been a topic worthy of further exploration as a result of the high prevalence rates of women presenting in gynecologic settings with depressive, anxiety, or eating-disordered symptoms. The detrimental effects of psychopathology have been well documented in the literature, especially if present during pregnancy. This article provides a review of the literature in the area of clinical practice related to mental health among obstetrician-gynecologists based on searches of the Psyc Info and MEDLINE databases. Lack of recognition and underdiagnosis are common problems that need to be addressed by focused educational initiatives. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader should be able to recall the importance of screening for various types of mental disease during an ob/gyn visit; describe the detrimental effects of psychopathology, especially during pregnancy; and explain the importance of educational initiatives in detecting and treating mental disorders.

Obstetrician/gynecologists' career satisfaction with certain work-related activities was examined among clinicians who perform deliveries and clinicians who do not.A questionnaire was sent to 1500 member-fellows of the American College of Obstetricians and Gynecologists; 842 members (56%) responded. The questionnaire was designed to distinguish between obstetrician/gynecologists who perform deliveries and clinicians who do not in the areas of satisfaction with specific aspects of career and work-related activities. Data were examined initially by multivariate analysis of variance and subsequently by univariate analysis of variance if the multivariate test was found to be significant.Workload and personal control were the primary factors for which there was a significant difference in satisfaction between clinicians who perform deliveries and clinicians who do not (P.001). Obstetrician/gynecologists who do not perform deliveries reported working significantly fewer hours per week (P.001) and had more satisfaction with their work activities than the delivery group overall. Despite lowered satisfaction with certain career aspects among the delivery Group, the highest positive disposition ratings that was given by respondents were for surgery, vaginal delivery, and planned cesarean delivery, with gender differences observed in the level of disposition for these particular activities. The most negative rating was reported for on-call/in-hospital time.Although positive disposition is associated with the activity of vaginal and cesarean delivery overall, 2 primary contributing factors of dissatisfaction that were identified among obstetrician/gynecologists who perform deliveries were increased workload and decreased personal control.

We examined screening practices and attitudes of obstetricians-gynecologists toward the use of noncombustible tobacco products (chewing tobacco, snuff/snus, electronic cigarettes, and dissolvables) during pregnancy.The authors mailed a survey in 2012 to 1024 members of the American College of Obstetricians and Gynecologists, including Collaborative Ambulatory Research Network (CARN) and non-CARN members. Stratified random selection was used to generate CARN and non-CARN samples.Response rates were 52% and 31% for CARN and non-CARN members, respectively. Of 252 total eligible respondents (those currently providing obstetrics care) 53% reported screening pregnant women at intake for noncombustible tobacco product use all or some of the time, and 40% reported none of the time. Respondents who reported that noncombustible products have adverse health effects during pregnancy, but are safer than cigarettes, ranged from 20.2% (dissolvables) to 29% (electronic cigarettes) and that the health effects are the same as those of cigarettes from 13.5% (electronic cigarettes) to 53.6% (chewing tobacco). Approximately 14% reported that electronic cigarettes have no adverse health effects;1% reported no health effects for the remaining products. Two-thirds of the respondents wanted to know more about the potential health effects of noncombustible tobacco products; only 5% believed themselves to be fully informed.A large proportion of obstetrician-gynecologists reported never or inconsistently screening their pregnant patients for the use of noncombustible tobacco products. Responses regarding the harms of these products relative to cigarettes were mixed and most respondents wanted more information. Development and dissemination of guidance for providers is needed to improve decision-making regarding noncombustible tobacco products.

OBJECTIVES To assess current obstetrician-gynecologist (ob-gyn) practice patterns related to the management of and barriers to smoking cessation during pregnancy and postpartum. METHODS A smoking cessation questionnaire was mailed to 1024 American College of Obstetricians and Gynecologists Fellows in 2012. χ(2) analyses were used to assess for categorical differences between groups, Pearson r was used to conduct correlational analysis, and analysis of variance was used to assess for mean differences between groups. RESULTS The analyses included 252 practicing ob-gyns who see pregnant patients who returned a completed survey. Ob-gyns estimated that 23% of their patients smoke before pregnancy, 18% smoke during first trimester, 12% during second trimester, and 11% during third trimester. They approximated that 32% quit during pregnancy, but 50% return to smoking postpartum. A large majority of ob-gyns feel that it is important for pregnant and postpartum women to quit smoking, and report asking all pregnant patients about tobacco use at the initial prenatal visit. Fewer ob-gyns follow-up on tobacco use at subsequent visits when the patient has admitted to use at a prior visit. The primary barrier to intervention was reported as time limitations, though other barriers were noted that may be addressable through the provision of additional training and resources offered to physicians. CONCLUSIONS Compared with findings from a similar study conducted in 1998, physicians are less likely to adhere to the 5 As smoking cessation guideline at present. As we know that brief intervention is effective, it is imperative that we work toward addressing practice gaps and providing additional resources to address the important public health issue of smoking during pregnancy and postpartum.

The purpose of this study was to determine tobacco use and dependence patterns over the course of 12 months among an adolescent population entering substance abuse treatment. The sample consisted of intake and 3-, 6-, and 12-month post-intake tobacco use data from 1062 adolescents within 34 substance abuse treatment facilities across the United States. Data were pooled across sites and analyzed utilizing descriptive statistics; repeated measures analyses; multiple regression models; three-level hierarchical linear models; and hierarchical generalized linear modeling. The majority of the sample reported at least weekly tobacco use at intake. Over time, participants increased their total tobacco consumption and days of use while reporting less desire for help with cessation. Race/ethnicity was a factor in differing tobacco use patterns. Tobacco dependence rates remained stable from intake to 3 months post-intake, decreased at 6 months post-intake, and rose to its highest levels at 12 months post-intake. Participants attended one smoking cessation class on average in each 90 day time period. Results suggest that adolescents entering substance use treatment may benefit from integrated tobacco cessation interventions that are intensive and occur early in treatment.

Substance use during pregnancy is widely acknowledged as a major public health concern with detrimental effects on both mother and unborn child. Mental health issues often co-occur with substance use and may trigger continued use during pregnancy or relapse to use postpartum, though little is known about the extent of these issues in pregnant and postpartum women entering substance abuse treatment. The purpose of this study is: (a) to examine self-reported mental health in a population of women and girls who were pregnant in the past year and are entering substance abuse treatment, and (b) to determine whether disparity exists in mental health treatment received across groups by race and age if a treatment need is present. Secondary data analysis was conducted with Global Appraisal of Individual Needs (GAIN) data from 502 female adolescents and adults who reported having been pregnant in the past year and who completed the GAIN upon entry into substance abuse treatment. Participants were compared on demographic, diagnostic, and problem severity variables by race and age. Results indicate that mental health treatment need is high among the whole pregnant and postpartum sample, but African American and Hispanic women and girls are receiving less mental health treatment than other groups despite having a need for it. No mental health treatment acquisition disparity was found by age.

The association between smoking during pregnancy and adverse maternal/neonatal health outcomes is widely acknowledged, and recent health care reform has filled a much-needed gap by extending prenatal smoking cessation intervention coverage to all pregnant women on Medicaid. While more extensive coverage will improve quit rates during pregnancy, there continues to be a need to address high relapse rates in the postpartum period for both the insured and the uninsured. Smoking during the postpartum period exposes infants directly and indirectly to negative health effects, and has additional costs to mothers and society. Approximately 80% of women who quit smoking during pregnancy relapse in the first year postpartum, highlighting a need for effective continuing care that supports them through the challenging postpartum period when stress is high and motivations to stay quit may change. Existing relapse prevention interventions, typically delivered during pregnancy, have been found to be of little benefit during the postpartum period, suggesting the need for a more formal continuing care approach. Phone-based protocols are promising because they address the need for flexible access, and are known to be effective at increasing quit rates and sustained cessation.

To determine obstetrician-gynecologists' practice patterns of cesarean delivery on maternal request (CDMR) following the 2006 National Institutes of Health (NIH) State-of-the-Science conference on this topic, and compare them with those in their practice prior to the conference.Questionnaires were mailed to 612 American College of Obstetricians and Gynecologists fellows who participated in a 2006 preconference survey, with 59% responding. The survey assessed demographic characteristics, practice, attitudes, knowledge regarding potential risks and benefits, counseling practices, and department policies with regards to CDMR.The majority of obstetrician-gynecologists in our sample continues to believe that a woman has the right to CDMR, but fewer than in 2006 would agree to perform this procedure. In general, obstetrician-gynecologists associate more risks and fewer benefits with CDMR than in 2006.Some physicians have shifted their perception of CDMR risks and benefits since the NIH State-of-the-Science conference; however, practice patterns have not changed significantly.

Primary and repeat cesarean delivery rates have reached their highest levels both nationally and internationally, with 30.3% of live births in the United States being cesarean deliveries. Some cite the increase in cesarean delivery on maternal request (CDMR) as a contributing factor, although data have yet to confirm this. Concern about the rising number of cesareans performed, and the lack of clear knowledge about health outcomes for both mother and neonate as a result of this trend prompted the National Institute of Child Health and Human Development and the Office of Medical Applications of Research of the National Institutes of Health to convene a State-of-the-Science Conference on the topic of CDMR from March 27 to 29, 2006. Before this conference, a study was conducted by the American College of Obstetricians and Gynecologists to assess practice patterns and opinions related to CDMR among obstetrician-gynecologists. It was found that most obstetrician-gynecologists recognized an increased demand for CDMR in their practices. Conclusions from this study and the conference are reviewed along with more recent research on this topic.

Background—Major depressive disorder affects a substantial percentage of the U.S. population, and can be highly debilitating. Selective serotonin reuptake inhibitors are commonly prescribed to treat depression, but may not be as effective for more severe or persistent depression. Methods—The authors review data concerning the effects of corticosteroid synthesis inhibitors (CSIs) in the management of depressive disorders, present a hypothesis as to their possible mechanisms of action based on recent data suggesting synergistic effects of glucocorticoids on extrahypothalamic corticotropin-releasing hormone (CRH), and consider alternative hypotheses. Published reports evaluating the efficacy of CSIs in treating depression are reviewed and presented in light of recent findings regarding actions of glucocorticoids on the central CRH system. Results—Results from open label and double-blind studies by several groups have indicated that CSIs may be efficacious or of adjunctive value in some patients with depression, including those refractory to other agents; however, there is a need for more controlled studies. Several lines of data suggest that the mechanism of action of these agents may not be solely a function of inhibition of adrenal cortisol production. Conclusions—The authors propose that CSIs may be efficacious in part by reducing glucocorticoid enhancement of CRH action in neurons of the central nucleus of the amygdala and other structures outside the endocrine hypothalamus. Possible effects of systemically administered CSIs on glucocorticoid receptor regulation, neuroactive steroids, and classical monoamine systems are also discussed. We conclude that available clinical data suggest a potential role for CSIs in the management of depressive disorders, especially major depression with psychotic features.

The objective of this study was to examine obstetrician-gynecologists' diagnostic accuracy for mental health issues during pregnancy through utilization of clinical vignettes describing depressive and anxiety symptoms, as well as to explore factors associated with increased diagnostic accuracy and related practice patterns. Questionnaires were mailed to 1193 American College of Obstetricians and Gynecologists Fellows and Junior Fellows. The response rate was 44% after three mailings. Depression was correctly identified by over 90% of respondents, whereas significantly fewer correctly diagnosed panic disorder (55%) and generalized anxiety disorder (32%). Confidence ratings significantly predicted diagnostic accuracy in some cases. Approximately half of respondents reported referring anxiety disordered patients to a mental health professional. There may be an education gap in ob-gyns' diagnostic knowledge of anxiety disorders, which may addressed by increasing physician confidence in diagnosis through increased training.

As obstetrician-gynecologists (ob-gyns) take on a greater role in women's healthcare, it is important that they are aware of the high prevalence of anxiety disorders in their patient population. Anxiety disorders present during pregnancy can have detrimental effects on both mother and child. In this study, we queried 1,193 ob-gyns on their screening rates, practice patterns, training, and knowledge as they relate to anxiety disorders during pregnancy. We achieved a 44% response rate (n=397) after three mailings. Physicians reported a moderate interest in screening for and diagnosing anxiety, but less interest in treatment. Only 20% of respondents (n=79) screen for anxiety during pregnancy, and they typically refer anxiety-disordered patients to mental health professionals. Ob-gyns with comprehensive or adequate training were significantly more likely to screen than those who stated that their training was inadequate. Having a friend who has been diagnosed with an anxiety disorder also significantly increased both the likelihood that these physicians would screen and the reported level of interest in screening of anxiety disorders during pregnancy. At present, the majority of ob-gyns feel that their training in this area was barely adequate to inadequate. Specifically, generalized anxiety disorder may be the least understood. Increased training in this area would allow ob-gyns to overcome what they list as the primary barrier to anxiety screening during pregnancy—that is, inadequate training about anxiety disorders. Depression and Anxiety 0:1–10, 2007. Published © 2007 Wiley-Liss, Inc.

Aims: The study aims to describe the trajectory of smoking and mental health from first prenatal visit through 3 months postpartum and compare postpartum outcomes based on intake smoking status. Methods: The sample of 130 participantswas drawn frompregnant women attending their first prenatal visit at a low-income obstetrics clinic. Intake and 3month postpartumassessmentswere collected. Postpartum smoking status was based on self-report and urine cotinine validation. ‘Current smokers’ and ‘recent quitters’ were contrasted on demographic, smoking behaviors, and psychological variables. Results: The sample was predominately African-American (80%), never married (74%), currently smoking (69%), with a mean age of 26. Intake and postpartum data were available for 97 (75% follow-up rate). At intake current smokers reported smoking 66 of the past 90 days and 11 times per day (TPD); women who recently quit reported smoking 13 of the past 90 days and 7 TPD (between-group difference at p< .01). Current smokers reported moredepressive and stress symptomsat intake than recentquitters and less motivation to quit (p< .05). Postpartum current smokers reported smoking 64 of the past 90 days and 8 TPD; women who had quit at intake smoked 1 of the past 90 days and 0.2 TPD (all at p< .01). Depressive symptoms were not different between groups postpartum but stress symptoms were (p< .05). Motivation to quit declined for both groups postpartum (p< .05). The same women who had quit at intake remained quit postpartum (28%), though 65% reportedhaving quit smoking for at least oneweekduring their pregnancy. Conclusions: Pregnant women who quit smoking prior to their first prenatal visit aremore likely tobeabstinentpostpartum. Those who continued to smoke maintained a similar level of smoking postpartum, though a majority stopped smoking at least once during pregnancy, suggesting motivation to quit during pregnancy diminishes postpartum. Financial support:Supportedbyagrant fromtheNational Institute on Drug Abuse (7R34DA032683).

s / Drug and Alcohol Dependence 146 (2015) e202–e284 e249 Methods: Data were from interviewer-administered surveys from 3 cross-sectional respondent-driven sampling (RDS) studies conducted in 2005, 2009, and 2012, including persons ≥18 years who had injected illicit substances in the past year. RDSAT was used to calculate RDS weighted point estimates and differences considered significant if 95% CIs did not overlap. Results: PWIDs in later cycles (2005, 2009, 2012, respectively) were more likely to have health coverage (38%, 57%, 83%), access syringes at pharmacies (18%, 34%, 32%), and access free condoms (61%, 59%, 81%). PWIDs were less likely to report an HIV test in the past 12 months (75%, 52%, 52%). There was no change in most measures of interest, including the proportion unaware of theirHIV status, onanti-retroviral therapy, vaccinated for viral hepatitis, ever treated forhepatitis C, usually/alwaysusinga sterile syringe, having unprotected intercourse with serodiscordant partners, or entering drug or alcohol treatment. Conclusions:We foundevidence of improved access to syringes and health insurance consistent with interval policy changes, but not expected improvements in blood-borne virus screening or treatment. PWIDs in San Francisco remain unacceptably unaware of their HIV status (43% unaware) and with just 67% on ARVs, broadened treatment guidelines may not have impacted PWIDs as they have other populations. These findings suggest a need for a detailed assessment of PWID health and innovative interventions to improve disease screening and treatment. Financial support: Centers for Disease Control and Prevention. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.142 Differences between recent quitters and current smokers during pregnancy Victoria H. Coleman-Cowger1, Vinetha Belur1, Mishka Terplan2 1 Lighthouse Institute, Chestnut Health Systems, Bloomington, IL, United States 2 Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, United States Aims: The aim of this study was to investigate characteristics of and differences between women who quit smoking in early pregnancy (“recent quitters”) and women who continue to smoke (“current smokers”) through analysis of preliminary data from an ongoing randomized controlled trial. Methods: Intake assessments were collected from pregnant womenenrolled inaclinical trial investigatingaphone-based intervention for postpartum smoking cessation and relapse prevention. Participants were classified as either current smokers or recent quitters based on self-report, andwere contrasted on demographic and psychological variables utilizing ANOVA and logistic regression. Results: Of the 123 participants, 38 (31%) were recent quitters and83 (69%)were current smokers at intake. Current smokerswere more likely than recentquitters to reporthigher scoresonmeasures of depression (p=0.011); self-perceived stress (p=0.029); lifetime (p=0.008), past-year (p=0.005), and pastmonth (p=0.02) internalizing disorders; lifetime (p=0.001) and past-year (p=0.008) externalizing disorders, lifetime substance disorders (p=0.017), and count of significant barriers to quitting smoking (p=0.018). Recent quitters were more likely than current smokers to report readiness to quit (93% vs. 74%, p=0.000), were more likely to have started smoking later in life (17.4 vs. 15.1 years, p=0.001) andmore likely to report a higher count of motivations to quit (1.4 vs. 0.4, p=0.000). In logistic regression analysis only having a history of lifetime externalizing disorders (OR 0.55; 95% CI 0.31, 0.98]) and havingpastmonth tobaccodependence (OR0.38;95%CI0.19, 0.75]) were significant predictors of quit status at intake. Conclusions: Women who continue to smoke after learning they are pregnant differ from those who quit smoking. Smoking cessation interventions may be improved upon by assessing for mental health history and tobacco dependence as part of prenatal care. Financial support: Supported by NIDA grant R34DA032683. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.143 Effects of the dopamine D3/D2 receptor antagonist buspirone on food/cocaine choice in socially housed male cynomolgus monkeys Michael Coller, Paul W. Czoty, Michael A. Nader Physiology & Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, United States Aims: Dopamine D2-like receptors are prominently involved in mediating the abuse-related effects of cocaine. Accumulating evidence suggests that the D3 subtype represents an encouraging target for pharmacotherapies for cocaine abuse. In these experiments, we assessed the effects of the purported D3 receptor antagonist buspirone, administered by either the intravenous (i.v.) or oral (p.o.) route, on food/cocaine choice in socially housed male cynomolgusmonkeys. The use of socially housedmonkeys permits anassessmentofwhether theeffects of buspironearemodulatedby social variables.We have demonstrated that brain D2-like receptor availability and the behavioral effects of cocaine and other D2-like drugs are modulated by the social rank of the monkey. Methods: Eight dominantand nine subordinate-ranked monkeys served as subjects. Monkeys self-administered cocaine under a concurrent fixed-ratio schedule in which they chose between a food pellet and a cocaine injection (0.0, 0.003, 0.01, 0.03, and 0.1mg/kg per injection in consecutive components, with 10 total reinforcers per component). When cocaine choice was stable, subgroups of dominant and subordinate monkeys (n≥6) received buspirone i.v. (0.03–0.56mg/kg, 3min before the behavioral session) or p.o. (3.0–17.8mg/kg, 45min pre-session). The dependent variables of interest were percent cocaine choice, and the number of cocaine and food choices in each component. Results: Buspirone was 10 times more potent via the i.v. route. Both i.v. and p.o. buspirone decreased cocaine choice inmost dominantmonkeys (4/6); however, fewsubordinates (2/7)were affected when buspirone was given by either route. Conclusions: Taken together, the data suggest that effects of buspirone on the relative reinforcing strength of cocaine may be modulated by environmental variables, with greater decreases in cocaine choice observed in monkeys exposed to chronic environmental enrichment versus chronic social stress. Financial support: DA10584. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.144

Obstetrician/gynecologists are taking on more primary care responsibilities and thus are expected to have a wider base of medical knowledge on a variety of women's health issues. The Collaborative Ambulatory Research Network (CARN) was created in 1990 to investigate issues pertinent to women's health and to the practice of obstetrics and gynecology in the outpatient setting. This article summarizes the findings of CARN studies from 2001 to 2004, covering topics of abnormal pregnancy outcomes, complications of pregnancy, and psychologic disorders. Each study provides a glimpse into the current practice patterns, attitudes, and knowledge of the practicing obstetrician/gynecologist. Although aggregate results suggest that clinicians are consistent and knowledgeable in traditional areas of practice, there appears to be a need for comprehensive educational programs to increase clinicians' comfort level with and knowledge of many primary care issues.

OBJECTIVE: To investigate the impact of career pressures on career satisfaction and satisfaction with job-specific activities among obstetrician- gynecologists. METHODS: A questionnaire was sent to 1,500 member-Fellows of The American College of Obstetricians and Gynecologists in June 2001. The analyses were designed to examine the relationship between career pressures in 3 domains on clinicians' professional satisfaction. RESULTS: Overall career satisfaction and satisfaction with job-specific activities were both inversely related to the perceived impact of career pressures. The major impact reported was that liability insurance costs would shorten the duration of the members' careers. Managed care had less impact than liability, with moderate concern surrounding the limitation of diagnostic and treatment options. Obstetrician-gynecologists were less satisfied with their careers and job-specific activities if they believed the cost or time of obtaining continuing medical education requirements to be a burden. CONCLUSION: Career pressures produced by liability insurance costs have more negative impact on clinicians' satisfaction with their professional lives and job-specific activities than managed care and requirements for continuing medical education.

Vaginal birth after cesarean delivery (VBAC) is an increasingly controversial procedure. Apart from medicolegal issues, there is uncertainty about identifying patients at risk and questions about what is an appropriate emergency response time. The risk of uterine rupture, although small, is very significant. This study surveyed a random sample of 1200 fellows of the American College of Obstetricians and Gynecologists in mid-2003 to define trends over the past 5 years in the management of VBAC. The 639 responses received after 3 mailings represented a response rate of 53%. No gender differences were found between those who did and those who did not respond. Respondents in general felt that they were familiar with the benefits and risks of VBAC as well as with ACOG guidelines for identifying the best candidates and for properly using oxytocin to induce labor in the setting of VBAC. There was a strong consensus that encouraging the procedure will lower overall rates of operative delivery. Respondents were less certain that they can reliably determine which patients would be successes. Nearly all of them reported being more confident if there had been a previous vaginal birth. Multifetal gestation, obesity, and diabetes all were thought to compromise the outcome of VBAC. Nearly three fourths of respondents reported that more than half of women having a previous cesarean again had an operative delivery. Male physicians were likelier than females to do repeat cesarean deliveries. Nearly half the group reported doing more cesareans at present than 5 years earlier, and approximately one third were doing about the same number. The same trends were evident for repeat section deliveries. Respondents cited liability risk and patient preference as major reasons for increasing rates of repeat cesarean section. Only 29% of respondents believe that that the current U.S. rate of cesarean delivery is too high. Uncertainty continues about whether elective repeat section is the safest procedure for the infant. Obstetricians/gynecologists appear to be well aware of the benefits and risks of VBAC, but doubt remains about which women should be offered a trial of labor and about what factors predict successful VBAC.