Barriers to Offering Vasectomy at Publicly Funded Family Planning Organizations in Texas

Few publicly funded family planning clinics in the United States offer vasectomy, but little is known about the reasons this method is not more widely available at these sources of care. Between February 2012 and February 2015, three waves of in-depth interviews were conducted with program administrators at 54 family planning organizations in Texas. Participants described their organization’s vasectomy service model and factors that influenced how frequently vasectomy was provided. Interview transcripts were coded and analyzed using a theme-based approach. Service models and barriers to providing vasectomy were compared by organization type (e.g., women’s health center, public health clinic) and receipt of Title X funding. Two thirds of organizations did not offer vasectomy on-site or pay for referrals with family planning funding; nine organizations frequently provided vasectomy. Organizations did not widely offer vasectomy because they could not find providers that would accept the low reimbursement for the procedure or because they lacked funding for men’s reproductive health care. Respondents often did not perceive men’s reproductive health care as a service priority and commented that men, especially Latinos, had limited interest in vasectomy. Although organizations of all types reported barriers, women’s health centers and Title X-funded organizations more frequently offered vasectomy by conducting tailored outreach to men and vasectomy providers. A combination of factors operating at the health systems and provider level influence the availability of vasectomy at publicly funded family planning organizations in Texas. Multilevel approaches that address key barriers to vasectomy provision would help organizations offer comprehensive contraceptive services.Population Research Cente

Hypertension among Oral Contraceptive Users in El Paso, Texas

On the U.S.-Mexico border, residents frequently cross into Mexico to obtain medications or medical care. We previously reported relatively high prevalence of hypertension among Latina oral contraceptive users in El Paso, particularly those obtaining pills over the counter (OTC) in Mexico. Here, we examine factors associated with having hypertension among 411 OTC users and 399 clinic users. We also assess hypertension awareness and interest in using blood pressure kiosks. Women age 35 to 44 and who had BMI ≥ 30 kg/m2 had higher odds of having hypertension. 59% of hypertensive women had unrecognized hypertension, and 77% of all participants would use a blood pressure kiosk; there were no significant differences between clinic and OTC users. Alternative approaches to increase access to health screenings are needed in this setting, where OTC pill use among women with unrecognized hypertension confers unique health risksPopulation Research Cente

The Impact of Information about Abortion Safety on Texas Voters’ Opinions about Restrictive Laws

A substantial gap exists between the scientific evidence demonstrating the safety of abortion in the United States and public opinion about abortion safety. But recent studies suggest that it may be possible to change perceptions about health issues that are based on misinformation. This brief, by researchers from the Texas Policy Evaluation Project, demonstrates that informational statements about the safety of office-based abortion care as currently practiced in Texas significantly reduced perceptions that ambulatory surgical center and admitting privileges requirements would make abortion safer and reduced support for these requirements.Population Research Cente

Demographic Change and the Structure of Wages: A Demand-Theoretic Analysis for Brazil

With rapidly declining fertility and increased longevity the age structure of the labor force in developing countries has changed rapidly. Changing relative supply of workers by age group, and by educational attainment, can have profound effects on labor costs. Their impacts on earnings have been heavily studied in the United States but have received little attention in Asia and Latin America, where supply shocks are at least as large and have often proceeded less evenly across the economy. We use data on 502 local Brazilian labor markets from Censuses 1970-2000 to examine the extent of substitution among demographic groups as relative supply has changed. The results suggest that age-education groups are imperfect substitutes, so that larger age-education cohorts see depressed wage rates, particularly among more-educated groups. The extent of substitution has increased over time, so that the decreasing size of the least-skilled labor force today is barely raising its remaining members' wages.

Impact of extreme weather on healthcare utilization by people with hiv in metropolitan miami

Extreme weather events (EWE) are expected to increase as climate change intensifies, leaving coastal regions exposed to higher risks. South Florida has the highest HIV infection rate in the United States, and disruptions in clinic utilization due to extreme weather conditions could affect adherence to treatment and increase community transmission. The objective of this study was to identify the association between EWE and HIV-clinic attendance rates at a large academic medical system serving the Miami-Dade communities. The following methods were utilized: (1) Extreme heat index (EHI) and extreme precipitation (EP) were identified using daily observations from 1990–2019 that were collected at the Miami International Airport weather station located 3.6 miles from the studied HIV clinics. Data on hurricanes, coastal storms and flooding were collected from the National Oceanic and Atmospheric Administration Storms Database (NOAA) for Miami-Dade County. (2) An all-HIV clinic registry identified scheduled daily visits during the study period (hurricane seasons from 2017–2019). (3) Daily weather data were linked to the all-HIV clinic registry, where patients’ ‘no-show’ status was the variable of interest. (4) A time-stratified, case crossover model was used to estimate the relative risk of no-show on days with a high heat index, precipitation, and/or an extreme natural event. A total of 26,444 scheduled visits were analyzed during the 383-day study period. A steady increase in the relative risk of ‘no-show’ was observed in successive categories, with a 14% increase observed on days when the heat index was extreme compared to days with a relatively low EHI, 13% on days with EP compared to days with no EP, and 10% higher on days with a reported extreme weather event compared to days without such incident. This study represents a novel approach to improving local understanding of the impacts of EWE on the HIV-population’s utilization of healthcare, particularly when the frequency and intensity of EWE is expected to increase and disproportionately affect vulnerable populations. More studies are needed to understand the impact of EWE on routine outpatient settings

Searching for plasticity in dissociated cortical cultures on multi-electrode arrays

We attempted to induce functional plasticity in dense cultures of cortical cells using stimulation through extracellular electrodes embedded in the culture dish substrate (multi-electrode arrays, or MEAs). We looked for plasticity expressed in changes in spontaneous burst patterns, and in array-wide response patterns to electrical stimuli, following several induction protocols related to those used in the literature, as well as some novel ones. Experiments were performed with spontaneous culture-wide bursting suppressed by either distributed electrical stimulation or by elevated extracellular magnesium concentrations as well as with spontaneous bursting untreated. Changes concomitant with induction were no larger in magnitude than changes that occurred spontaneously, except in one novel protocol in which spontaneous bursts were quieted using distributed electrical stimulation

Cold collisions of OH and Rb. I: the free collision

We have calculated elastic and state-resolved inelastic cross sections for cold and ultracold collisions in the Rb($^1 S$) + OH($^2 \Pi_{3/2}$) system, including fine-structure and hyperfine effects. We have developed a new set of five potential energy surfaces for Rb-OH($^2 \Pi$) from high-level {\em ab initio} electronic structure calculations, which exhibit conical intersections between covalent and ion-pair states. The surfaces are transformed to a quasidiabatic representation. The collision problem is expanded in a set of channels suitable for handling the system in the presence of electric and/or magnetic fields, although we consider the zero-field limit in this work. Because of the large number of scattering channels involved, we propose and make use of suitable approximations. To account for the hyperfine structure of both collision partners in the short-range region we develop a frame-transformation procedure which includes most of the hyperfine Hamiltonian. Scattering cross sections on the order of $10^{-13}$ cm$^2$ are predicted for temperatures typical of Stark decelerators. We also conclude that spin orientation of the partners is completely disrupted during the collision. Implications for both sympathetic cooling of OH molecules in an environment of ultracold Rb atoms and experimental observability of the collisions are discussed.Comment: 20 pages, 16 figure

Evaluation of Coach-Based Technical Assistance: An Evolving Focus on Coachability and Goal Setting

In 2013, the National Institute of Food and Agriculture supported the creation of a professional development and technical assistance center to promote strong implementation and evaluation of University-led, community-based projects serving low-resource populations. Within this center, a coaching cadre was established to provide proactive and responsive technical assistance. Formative evaluation involving coaches and their primary contacts was used for refinement of coaching practices. Initially, coaches were encouraged to build strong interpersonal rapport. This set the stage for trusting, reciprocal interactions, but coaches recognized a need for targeted support and more tools for quality programming, evaluation, and sustainability. Greater emphasis was placed on goal-focused collaboration. Coaches received training and resources on topics such as goal setting, program quality, reduction of barriers (e.g., participant recruitment), and sustainability strategies. To assess coaching model enhancements, a survey of projects was expanded to gauge logic model usage, goal setting, strength of coaching relationships, and project implementation and sustainability progress. Overall, coaching was rated more favorably and effective when contact was consistent, inclusive of face-to-face interaction, met technical needs, and involved collaborative brainstorming and planning. Findings indicate coaching relationships strengthen over time and demand a collaborative, action-orientation to set goals, reduce barriers, and drive stronger outcomes

Contraindications of progestin-only oral contraceptive pills among reproductive-aged women

BACKGROUND: Progestin-only oral contraceptive pills (POPs) have fewer contraindications to use compared to combined pills. However, the overall prevalence of contraindications to POPs among reproductive aged women has not been assessed. STUDY DESIGN: We collected information on contraindications to POPs in two studies : 1) the Self-Screening Study, a sample of 1,267 reproductive aged women in the general population in El Paso, Texas and 2) the Prospective Study of Oral Contraceptive (OC) Users, a sample of current OC users who obtained their pills in El Paso clinics (n=532) or over the counter (OTC) in Mexican pharmacies (n=514). In the Self-Screening Study, we also compared women’s self-assessment of contraindications using a checklist to a clinicain’s evaluation. RESULTS: Only 1.6% of women in the Self-Screening Study were identified as having at least one contraindication to POPs. The sensitivity of the checklist for identifying women with at least one contraindication was 75.0% (95% CI: 50.6-90.4%), and the specificity was 99.4% (95% CI: 98.8-99.7%). In total, 0.6% of women in the Prospective Study of OC Users reported having any contraindication to POPs. There were no significant differences between clinic and OTC users. CONCLUSION: The prevalence of contraindications to POPs was very low in these samples. POPs may be the best choice for the first OTC oral contraceptive in the US.The Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD047816).http://www.journals.elsevier.com/contraception