Population Policy:Abortion and Modern Contraception are Substitutes

A longstanding debate exists in population policy about the relationship between modern contraception and abortion. Although theory predicts that they should be substitutes, the empirical evidence is difficult to interpret. What is required is a large-scale intervention that alters the supply (or full price) of one or the other and, importantly, that does so in isolation (reproductive health programs often bundle primary health care and family planning—and in some instances, abortion services). In this article, we study Nepal’s 2004 legalization of abortion provision and subsequent expansion of abortion services, an unusual and rapidly implemented policy meeting these requirements. Using four waves of rich individual-level data representative of fertile-age Nepalese women, we find robust evidence of substitution between modern contraception and abortion. This finding has important implications for public policy and foreign aid, suggesting that an effective strategy for reducing expensive and potentially unsafe abortions may be to expand the supply of modern contraceptives. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s13524-016-0492-8) contains supplementary material, which is available to authorized users

Trauma in Veterans with Substance Use Disorder: Similar Treatment Need among Urban and Rural Residents

Purpose: The objective of this study is to determine whether rural residence is associated with trauma exposure or posttraumatic stress disorder symptoms among military veterans seeking treatment for substance use disorder (SUD) through the Department of Veterans Affairs (VA). Delivering mental health services to veterans in rural areas is a challenge, so identifying differences in the causes and outcomes of trauma exposure would assist in effectively targeting service delivery. Methods: Veterans (N = 196) entering SUD treatment at 3 Midwestern VA treatment centers were designated as either urban or rural, based on rural-urban commuting area (RUCA) codes. The veterans completed the Life Events Checklist, the Posttraumatic Stress Disorder Checklist, and the Addiction Severity Index’s psychiatric status subscale. Hypothesized relationships between rural-urban residence and both trauma exposure and symptomology were tested using independent samples t tests, chi-square tests, and ordinary least squares regression. Findings: The range of traumatic experiences was similar between rural and urban veterans, and rural-urban residence was not significantly associated with the overall array of traumas experienced or the symptom measures’ overall scores or subscores. Of 17 possible traumatic lifetime experiences, rural veterans differed from urban veterans on only 2, reporting significantly lower rates of transportation accidents and unwanted sexual experiences. Conclusions: In both the causes of trauma and the need for treatment, veterans residing in rural areas differ little from their urban counterparts

Predictors of Comorbid Eating Disorders and Association with Other Obsessive-Compulsive Spectrum Disorders in Trichotillomania

Trichotillomania (TTM) and eating disorders (ED) share many phenomenological similarities, including ritualized compulsive behaviors. Given this, and that comorbid EDs may represent additional functional burden to hair pullers, we sought to identify factors that predict diagnosis of an ED in a TTM population. Subjects included 555 adult females (age range 18–65) with DSM-IV-TR TTM or chronic hair pullers recruited from multiple sites. 7.2% (N = 40) of our TTM subjects met criteria for an ED in their lifetime. In univariable regression analysis, obsessive-compulsive disorder (OCD), Yale-Brown Obsessive Compulsive Scale (Y-BOCS) worst-ever compulsion and total scores, certain obsessive-compulsive spectrum disorders, anxiety disorder, attention-deficit/hyperactivity disorder (ADHD), and substance disorder all met the pre-specified criteria for inclusion in the multivariable analysis. In the final multivariable model, diagnosis of OCD (OR: 5.68, 95% CI: 2.2–15.0) and diagnosis of an additional body-focused repetitive behavior disorder (BFRB) (OR: 2.69, 95% CI: 1.1–6.8) were both associated with increased risk of ED in TTM. Overall, our results provide further support of the relatedness between ED and TTM. This finding highlights the importance of assessing for comorbid OCD and additional BFRBs in those with TTM. Future research is needed to identify additional predictors of comorbid disorders and to better understand the complex relationships between BFRBs, OCD and EDs

Steps to Growing Up Healthy: a Pediatric Primary Care Based Obesity Prevention Program for Young Children

Background Leading medical organizations have called on primary care pediatricians to take a central role in the prevention of childhood obesity. Weight counseling typically has not been incorporated into routine pediatric practice due to time and training constraints. Brief interventions with simple behavior change messages are needed to reach high-risk children, particularly Latino and Black children who are disproportionately affected by obesity and related comorbidities. Steps to Growing Up Healthy (Added Value) is a randomized controlled trial testing the efficacy of brief motivational counseling (BMC) delivered by primary care clinicians and the added value of supplementing BMC with monthly contact by community health workers (CHW) in the prevention/reversal of obesity in Latino and Black children ages 2-4 years old. Methods/Design Mother-child dyads (targeted n=150) are recruited for this 12-month randomized trial at an inner-city pediatric primary care clinic and randomized to: 1) BMC delivered by clinicians and nurses at well, sick, and WIC visits with the goal of reducing obesogenic behaviors (BMC); 2) BMC plus monthly phone calls by a CHW (BMC+Phone); or 3) BMC plus monthly home visits by a CHW (BMC+Home). During BMC, the medical team facilitates the selection of a specific goal (i.e., reduce sugar sweetened beverage consumption) that is meaningful to the mother and teaches the mother simple behavioral strategies. Monthly contacts with CHWs are designed to identify and overcome barriers to goal progress. Dyads are assessed at baseline and 12 months and the primary outcome is change in the child’s BMI percentile. We hypothesize that BMC+Phone and BMC+Home will produce greater reductions in BMI percentiles than BMC alone and that BMC+Home will produce greater reductions in BMI percentiles than BMC+Phone. Discussion Steps to Growing Up Healthy will provide important information about whether a brief primary care-based intervention that utilizes a motivational interviewing and goal setting approach can be incorporated into routine care and is sufficient to prevent/reverse obesity in young children. The study will also explore whether monthly contact with a community health worker bridges the gap between the clinic and the community and is an effective strategy for promoting obesity prevention in high-risk families

Intensive Referral of Veterans to Mutual-Help Groups: A Mixed-Methods Implementation Evaluation

Community-based support group participation protects against substance use disorder (SUD) relapse, but referrals during treatment are inconsistently delivered and may not acknowledge barriers facing rural patients. This formative evaluation of a rural intensive referral intervention (RAIR) to community-based support groups for veterans seeking SUD treatment surveyed patients (N = 145) and surveyed and interviewed treatment staff (N = 28). Patients and staff did not differ significantly on quantitative ratings of the helpfulness of, or satisfaction with, seven RAIR components, but staff did not deliver the intervention consistently or as designed, citing two themes: lack of commitment and lack of resources

Intensive Referral to Mutual-Help Groups: A Field Trial of Adaptations for Rural Veterans

Objective: A multisite field trial testing whether improved outcomes associated with intensive referral to mutual help groups (MHGs) could be maintained after the intervention was adapted for the circumstances and needs of rural veterans in treatment for substance use disorder (SUD). Methods: In three Veterans Affairs treatment programs in the Midwest, patients (N = 195) received standard referral (SR) or rural-adapted intensive referral (RAIR) and were measured at baseline and 6-month follow-up. Results: Both groups reported significant improvement at 6 months but no significant differences between SR and RAIR groups in MHG participation, substance use, addiction severity, and posttraumatic stress symptoms. Inconsistent delivery of the intervention resulted in only one-third of the RAIR group receiving the full three sessions, but this group reported significantly greater 6-month abstinence from alcohol than those receiving no sessions. Conclusion: Further research should explore implementation problems and determine whether consistent delivery of the intervention enhances 12-step facilitation. Practice implications: The addition of rural-specific elements to the original intensive referral intervention has not been shown to increase its effectiveness among rural veterans

Offseason Body Composition Changes Detected by Dual-Energy X-Ray Absorptiometry Versus Multifrequency Bioelectrical Impedance Analysis in Collegiate American Football Athletes

In American football, offseason training is designed to promote increases in muscle strength and size in athletes. Tracking changes in body composition may confer key information about the effectiveness of training programs to football practitioners. PURPOSE: The present study assessed the relationship between body composition changes estimated by dual-energy x-ray absorptiometry (DXA) and bioelectrical impedance analysis (BIA) in football players during the initial period of an offseason training program. METHODS: Body composition in 29 NCAA Division III American football players (mean ± SD; age: 19.7 ± 1.5 y; height: 179.8 ± 6.6 cm; body mass [BM]: 96.1 ± 12.6 kg; DXA body fat: 20.9 ± 4.4%) was estimated using BIA (InBody 770) and DXA (Hologic Horizon) before and after a seven-week training intervention. Repeated measures analysis of variance, concordance correlation coefficients, and Bland-Altman analysis alongside linear regression were used to detect differences in cross-sectional estimates and change values, the strength of correlation, and determine the degree of proportional bias between methods, respectively. RESULTS: Significant method by time interactions were observed for BM (p = 0.03), arms fat-free mass (FFM) (p = 0.03), and legs FFM (p = 0.01). Post hoc comparisons indicated that DXA – but not BIA – detected increases in FFM of the arms and legs. Time main effects indicated an increase in total FFM (p = 0.004) and trunk FFM (p = 0.002) from pre to post. Finally, method main effects indicated higher leg FM values for DXA (p \u3c 0.001) and higher trunk FM values for BIA (p \u3c 0.001). No significant effects were observed for total FM (p = 0.92) or arms FM (p = 0.13). Changes in total BM (CCC = 0.96), FFM (CCC = 0.49), and fat mass (CCC = 0.50) were significantly correlated between BIA and DXA. CONCLUSION: DXA and BIA may similarly track increases in whole-body FFM in American collegiate football players; however, BIA may possess less sensitivity to detect segmental FFM increases, particularly in the appendages

Influenza Vaccine Effectiveness against Hospitalisation with Confirmed Influenza in the 2010-11 Seasons: A Test-negative Observational Study

Immunisation programs are designed to reduce serious morbidity and mortality from influenza, but most evidence supporting the effectiveness of this intervention has focused on disease in the community or in primary care settings. We aimed to examine the effectiveness of influenza vaccination against hospitalisation with confirmed influenza. We compared influenza vaccination status in patients hospitalised with PCR-confirmed influenza with patients hospitalised with influenza-negative respiratory infections in an Australian sentinel surveillance system. Vaccine effectiveness was estimated from the odds ratio of vaccination in cases and controls. We performed both simple multivariate regression and a stratified analysis based on propensity score of vaccination. Vaccination status was ascertained in 333 of 598 patients with confirmed influenza and 785 of 1384 test-negative patients. Overall estimated crude vaccine effectiveness was 57% (41%, 68%). After adjusting for age, chronic comorbidities and pregnancy status, the estimated vaccine effectiveness was 37% (95% CI: 12%, 55%). In an analysis accounting for a propensity score for vaccination, the estimated vaccine effectiveness was 48.3% (95% CI: 30.0, 61.8%). Influenza vaccination was moderately protective against hospitalisation with influenza in the 2010 and 2011 seasons

The Effects of a Thermogenic Supplement on Metabolic and Hemodynamic Variables and Subjective Mood States

Thermogenic supplements are widely used in the general population to support attempted fat loss; however, the efficacy and safety of these supplements are questioned. PURPOSE: To determine whether a thermogenic supplement affects metabolic rate, hemodynamic responses, and mood states. METHODS: In a randomized double-blind crossover design, 23 females (22.2 ± 3.5 y; 164.8 ± 6.4 cm; 73.5 ± 6.9 kg) who were moderate caffeine consumers (\u3c150mg/day) reported to the lab on a 12-hour fast for baseline assessments of resting energy expenditure (REE) via indirect calorimetry, heart rate (HR), blood pressure (SBP and DBP), and hunger, satiety, and mood states. Thereafter, subjects ingested the assigned treatment (active treatment containing caffeine, micronutrients, and phytochemicals [TR] or placebo [PL]). All variables were reassessed at 30-, 60-, 120-, and 180-minutes post-ingestion. Subjects repeated the same protocol with ingestion of the opposite treatment on a separate day. All data were analyzed using a 2x5 ANOVA with repeated measures and significance was accepted a priori at p\u3c0.05. RESULTS: In the TR group, mean increases in REE of 121 to 166 kcal/d were observed at 30-, 60-, and 180-minutes post-ingestion (p\u3c0.01 for all). PL group mean decreases in REE of 72 to 91 kcal/d were observed at 60-, 120-, and 180-minutes (p\u3c0.05 for all). Similarly, TR resulted in mean increases in expired carbon dioxide of 13 to 19 mL/min at 30- and 60-minutes (p\u3c0.05 for both), and oxygen consumption increased by 12 to 24 mL/min at 30-, 60-, 120-, and 180-minutes (p\u3c0.05 for all) post-ingestion. Respiratory quotient decreased at 120- and 180-minutes in both treatments. A mean decrease in HR of 5 bpm was observed at 30-minutes post-ingestion of TR (p\u3c0.01). Slight increases in SBP of 3 to 4 mmHg were observed at 30-, 120-, and 180-minutes (p\u3c0.05 for all) post-ingestion of TR, while no effects were observed for DBP. Observed increases in SBP were within normal blood pressure ranges. TR decreased subjective fatigue with no other significant changes in mood states. CONCLUSION: These findings indicate that ingestion of a specific thermogenic supplement formulation produces a sustained increase in metabolic rate and caloric expenditure and reduces fatigue over three hours without producing adverse hemodynamic responses

Relationship Between Changes in Upper Body Fat-Free Mass and Bench Press Performance in American Football Players

Horizontal pushing strength and strength endurance are relevant attributes for blocking and block shedding in American football. Since most positions in American football require the ability to either block or shed a block, and since bench press repetitions to failure (RTF) with 225 pounds is a component of the NFL draft combine, improving horizontal pushing strength and strength endurance have been key areas of emphasis for strength and conditioning coaches working with these athletes. PURPOSE: The purpose of this analysis was to quantify the relationship between changes in upper body fat-free mass (FFM) and metrics of bench press performance in American football players. METHODS: Body composition and muscular performance were assessed in NCAA Division III American football players. Upper body FFM was obtained from dual-energy X-ray absorptiometry (DXA; Hologic Horizon) before and after a seven-week offseason training period. Barbell bench press one-repetition maximum (1RM), incline barbell bench press 1RM, and RTF with 225 pounds on the barbell bench press were also determined before and after the training period. Using Spearman’s rank correlations, the relationships between percent changes in upper body FFM and bench press 1RM (n=19), bench press RTF with 225 pounds (n=15), and incline bench press 1RM (n=18) were evaluated. RESULTS: Relative changes in bench press 1RM and DXA upper body FFM exhibited a weak, non-significant correlation (ρ: 0.38, p: 0.11). However, there was a moderate strength, significant correlation between relative changes in bench press RTF with 225 pounds and DXA upper body FFM (ρ: 0.53, p: 0.04). For relative changes in incline bench press 1RM, there was a weak, non-significant correlation with DXA upper body FFM (ρ: 0.24, p: 0.36). CONCLUSION: Of the performance tests assessed, only changes in bench press RTF with 225 pounds and changes in DXA upper body FFM were positively correlated. Therefore, strength and conditioning coaches working with athletes who plan on entering the NFL draft may want to consider dedicating time to increasing upper body FFM gains prior to the draft as it appears to be positively correlated with performance on this NFL combine test