The Association Between Substances Related Behavior and High Blood Pressure Among Women in the United States

Introduction Cardiovascular disease (CVD) is the leading cause of death for women in the United States, causing one in every five female deaths, and high blood pressure is a precursor to CVD. Approximately half a million people attend the emergency departments with complications arising from substance use, many of which are concerned with cardiovascular events. The higher the number of substances used, the greater the risk of cardiovascular heart diseases; this association is even stronger among women than men. The purpose of this study is to determine the extent to which women\u27s substance-related behavior impacts high blood pressure, which in turn is a significant risk factor for cardiovascular disease in the US. Methods This cross-sectional study used the 2019 Behavioral Risk Factor Surveillance System (BRFSS) to examine the relationship between having blood pressure and women who smoke and engage in binge drinking. Women who responded yes, yes during pregnancy and were told borderline high or pre-hypertensive to the question of ever been told by a doctor, nurse or another health professional that you have high blood pressure” were categorized as having high blood pressure. Those who responded no, don’t know/not sure, and refused were considered as not having high blood pressure. Smoking and binge drinking were the two key independent variables for this study. Women were categorized into 4-level smoker status: everyday smoker, someday smoker, former smoker, and non-smoker. Binge drinkers were women who takes four or more drinks on one occasion, with responses being yes, no or don\u27t know/refused/missing.” A chi-square test for independence was examined to determine the association between having high blood pressure and smoking or binge drinking. Multivariable regression analysis was also performed to account for other factors (such as age, race, educational attainment, income, body mass index and blood cholesterol) potentially associated with high blood pressure among women. Results Approximately 418, 264 individuals responded to the survey items. Among respondents are 227,706 women, who are the study population of interest. The women included in this study are 18-34, 35-64, and above 65 years old. Among the study population, 33% reported having high blood pressure with no record of high blood pressure, amongst 67%. Among women who reported binge drinking, 22.9% reported high blood pressure compared to 34.6% of women who did not binge drink (p= Conclusion This study found that substance abuse was not associated with having high blood pressure. It is possible that women with high blood pressure quit or reduced these behaviors due to a high blood pressure diagnosis. Notwithstanding the high prevalence of high blood pressure and substance use, further research is needed to examine this association among women overall and subpopulations at high risk. This research should support prioritizing interventions and informing public health programs

Breast Cancer Outcomes in Younger Women: A Systematic Review of the Literature on Locoregional Management

Background: Despite significant advances in the treatment and management of breast cancer, young women diagnosed before the age of 40 have worse outcomes as compared to older women with similar cancers. Many posit that this occurrence is related to a propensity to develop more biologically aggressive tumors, while others attribute these differences to the influences of estrogen on this young cohort. Nevertheless, many of the therapeutic measures offered to young women are based on evidence derived from studies of older, post-menopausal women. Objective: To determine whether locoregional management of early-stage invasive breast cancer is associated with long-term survival outcomes in young women during the era of modern multimodal therapies. Methods: A systematic review of retrospective cohort studies published within the last 10 years. Results: Although younger women who undergo breast-conserving therapy (BCT) have higher rates of local recurrence (LR), this review indicates that either there is a slight survival advantage after BCT compared to mastectomy (M), or that there is no survival difference based on these interventions. Conclusion: Presently, there is insufficient evidence to determine whether younger women should continue to undergo more aggressive local treatment approaches, emphasizing the need for prospective controlled trials to generate more reliable information on the magnitude of survival benefits of BCT and M in young women.Master of Public Healt

An Undergraduate Curriculum in Public Health Benchmarked to the Needs of the Workforce

East Tennessee State University (ETSU) has offered an undergraduate degree in public health for 60 years. Alumni survey data have documented that the majority of the graduates from this program enter the workforce [see accompanying commentary by Wykoff, et al. (1)]. To keep pace with ongoing changes in the workforce, the decision was made to completely review, and, as appropriate, revise and restructure the Bachelor of Science in Public Health (BSPH) curriculum

Overweight and Obesity in the South: Prevalence and Related Health Care Costs Among Population Groups

Overweight and obesity are leading public health concerns in the United States. Although overweight and obesity are preventable conditions in the majority of cases, their prevalence has increased significantly over the past two decades. Recent estimates indicate that 34.1 percent of Americans are classified as overweight, while 32.2 percent are classified as obese [17]. National estimates of obesity-related health care costs are alarming, yet, to date, no such estimates have been published for the Southern region overall or for population groups in the South. The Southern states have some of the highest rates of adult obesity in the nation

Breast Cancer Fatalism: The Role of Women\u27s Perceptions of the Health Care System

Cancer fatalism, which can be understood as the belief that cancer is a death sentence, has been found to be a deterrent to preventive cancer screening participation. This study examines factors associated with breast cancer fatalism among women. We analyzed data from a 2003 survey of women 40 years of age. The survey collected information about respondents\u27 knowledge and attitudes regarding breast health. Analyses compared the characteristics of women who reported and those who did not report a fatalistic attitude. Women with a fatalistic attitude were more likely to be African American, to have a family history of breast cancer, to rate their quality of care as fair or poor, to believe that not much could be done to prevent breast cancer, to believe that breast cancer could not be cured if found early, and to believe that treatment could be worse than the disease

Clinical Service Delivery along the Urban/Rural Continuum

Background: Engagement in the core public health functions and ten essential services remains the standard for measuring local health department (LHD) performance; their role as providers of clinical services remains uncertain, particularly in rural and underserved communities. Purpose: To examine the role of LHDs as clinical service providers and how this role varies among rural and nonrural communities. Methods: The 2013 National Association of County and City Health Officials (NACCHO) Profile was used to examine the geographic distribution of clinical service provision among LHDs. LHDs were coded as urban, large rural, or small rural based on Rural/Urban Commuting Area codes. Bivariate analysis for clinical services was conducted by rural/urban status. For each service, the proportions of LHDs that directly performed the service, contracted with other organizations to provide the service, or reported provision of the service by independent organizations in the community was compared. Results: Analyses show significant differences in patterns of clinical services offered, contracted, or provided by others, based on rurality. LHDs serving rural communities, especially large rural LHDs, tend to provide more direct services than urban LHDs. Among rural LHDs, larger rural LHDs provided a broader array of services and reported more community capacity for delivery than small rural LHDs- particularly maternal and child health services. Implications: There are capacity differences between large and small rural LHDs. Limited capacity within small rural LHDs may result in providing less services, regardless of the availability of other providers within their communities. These findings provide valuable information on clinical service provision among LHDs, particularly in rural and underserved communities

Local Health Department Clinical Service Delivery along the Urban/Rural Continuum

Background: Engagement in the core public health functions and ten essential services remains the standard for measuring local health department (LHD) performance; their role as providers of clinical services remains uncertain, particularly in rural and underserved communities. Purpose: To examine the role of LHDs as clinical service providers and how this role varies among rural and nonrural communities. Methods: The 2013 National Association of County and City Health Officials (NACCHO) Profile was used to examine the geographic distribution of clinical service provision among LHDs. LHDs were coded as urban, large rural, or small rural based on Rural/Urban Commuting Area codes. Bivariate analysis for clinical services was conducted by rural/urban status. For each service, the proportions of LHDs that directly performed the service, contracted with other organizations to provide the service, or reported provision of the service by independent organizations in the community was compared. Results: Analyses show significant differences in patterns of clinical services offered, contracted, or provided by others, based on rurality. LHDs serving rural communities, especially large rural LHDs, tend to provide more direct services than urban LHDs. Among rural LHDs, larger rural LHDs provided a broader array of services and reported more community capacity for delivery than small rural LHDs- particularly maternal and child health services. Implications: There are capacity differences between large and small rural LHDs. Limited capacity within small rural LHDs may result in providing less services, regardless of the availability of other providers within their communities. These findings provide valuable information on clinical service provision among LHDs, particularly in rural and underserved communities

Characteristics of Current Hospital-Sponsored and Nonhospital Birth Centers

Objectives : (1) To describe contemporary birth centers in terms of the population served, organizational and financial characteristics, services provided, mission and philosophy, and planning and marketing techniques. (2) To compare hospital-sponsored and nonhospital models with regard to the above characteristics. Method : Data from the National Survey of Women's Health Centers conducted in 1994 are analyzed using t -tests and chi-square tests. Results : Contemporary birth centers serve a diverse population of women and provide a range of clinical and nonclinical services. Birth centers are both hospital-sponsored and nonhospital, with the former growing at a faster rate. Compared to hospital-sponsored centers, nonhospital centers serve a larger proportion of uninsured women, provide a broader range of clinical services, and are more committed to women-centered care. Centers utilize different marketing methods and are involved in a number of organizational changes to better position themselves in the changing health care environment. Conclusions: Birth centers offer an attractive option to consumers and are a viable model for delivering women-centered care. Given that all “birth center” facilities do not share the same philosophy and service mix, women need to have some assurance of what a “birth center” will, and will not, provide.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45317/1/10995_2004_Article_425315.pd

Do adolescents receive youth-friendly, person-centered contraceptive care at safety-net clinics in the U.S. South?: An examination of youths’ perspectives

Introduction: Improving the quality of contraceptive care that youth receive improves the patient-provider relationship, satisfaction with care, and contraceptive method use and continuation. In recent years, high-quality contraceptive care for youth has shifted away from tiered effectiveness counseling and toward youth-friendly, person-centered contraceptive counseling (YFPCCC). Rooted in the reproductive justice movement, YFPCCC requires that counseling encourages youth to say what matters to them in their contraceptive method, respects youth’s preferences in their contraceptive method, provides youth with the information necessary to make the best choice for them, and is respectful of youth’s choices. YFPCCC is especially important for minor youth and youth of color who have historically received biased care and for youth in the United States South where restrictive policies may prevent youth from receiving care. This study examined youths’ perspectives of YFPCCC at safety-net clinics in two states in the U.S. South. Methods: Between 2018 and 2022, a survey measuring patient perspectives of their contraceptive counseling was collected from youth (ages 16 to 24) who received care at federally qualified health centers (FQHCs) and health departments (HDs) in Alabama (AL) and South Carolina (SC). A total of 1,052 youth were included in the study (AL n=513 and SC n=539). Four survey items measuring the four components of person-centered counseling and two survey items measuring youth-friendliness (knowledgeable and trustworthy providers) were dichotomized into Yes/No responses and combined to create two new variables measuring PCCC and providers’ youth-friendliness. PCCC and youth friendliness were compared across clinic type, state, age, race/ethnicity, and insurance coverage using logistic regression. P-values less than 0.05 were considered significant. Results: Overall, 56% of youth in the study reported that they received all four components of PCCC and 71% reported that their providers were youth-friendly. Minor youth (ages 16 and 17) were 34% less likely than older youth (ages 20-24) to report receipt of PCCC (aOR 0.66, 95% confidence interval (CI) [0.45, 0.98]). Minor youth were also 39% less likely than older youth to report that their provider was youth-friendly (aOR 0.61, 95% CI [0.40, 0.93]). Non-Hispanic Black youth were 45% less likely than non-Hispanic White youth to report PCCC (aOR 0.55 95% CI [0.40, 0.70]). Similarly, non-Hispanic Black youth were 44% less likely than non-Hispanic White youth to report that their provider was youth-friendly (aOR 0.56 CI [0.41, 0.77]). Discussion: Providing contraceptive care that is both person-centered and youth-friendly is essential in improving the quality of care that youth receive. In this study, minors and non-Hispanic Black youth were the least likely to report that their care was both person-centered and youth-friendly. This gap in the quality of care that non-Hispanic Black youth receive may contribute to lower satisfaction with care which may contribute to lower contraceptive use rates and higher unintended teen birth rates for this group. Clinics can improve their ability to provide YFPCCC by ensuring providers are trained in youth-friendly and person-centered contraceptive care

Clinic Capacity to Provide Patient-centered Contraceptive Care to Adolescents in the U.S. South: Impact of Rurality and Clinic Type

Introduction: Federally qualified health centers (FQHCs) and health departments (HDs) are essential in providing contraceptive care and ensuring reproductive autonomy for adolescents. Through offering adolescent-specific services and by training providers in adolescent-specific care and patient-centered contraceptive counseling, clinics can ensure access to high quality contraceptive care for adolescents. Despite the significant decrease in adolescent pregnancy rates, rates remain high in the South and in rural counties, suggesting that clinics in these areas may not have the capacity to provide adolescent-specific services and patient-centered counseling. This study compares the capacity to provide adolescent-specific and patient-centered contraceptive services in rural and urban FQHCs and HDs in two southeastern states -- South Carolina (SC) and Alabama (AL). Methods: Data were collected from a statewide survey of FQHC and HD clinics in SC and AL in 2020. A total of 239 clinics were included (FQHC N=112 and HD N=127) and were identified as rural (N=101) or urban (N=138) using Rural-Urban Continuum Codes. Capacity to provide patient-centered adolescent care is defined as 1) a clinic offering adolescent-specific services; 2) providers at the clinic receiving training in patient-centered counseling; and 3) providers receiving training in adolescent-specific care. To measure capacity, these three survey items were dichotomized into Yes/No responses and then combined into a new variable to measure clinics who responded Yes to each survey item. The type of adolescent-specific services was also measured as being onsite, offsite, outreach, or none. Capacity to provide patient-centered adolescent care was compared across clinics located in rural and urban settings and by clinic type. Statistical differences were determined using the Chi-Square test of independence (α= 0.05). Results: Overall, 44.8% of participating clinics in SC and AL had the capacity to provide patient-centered adolescent contraceptive services. Approximately 51.8% of rural and 66.1% of urban HDs reported the capacity to provide adolescent-specific services. In contrast, 26.7% of rural and 35.4% of urban FQHCs reported the capacity to provide adolescent-specific services. Approximately 55.4% of rural and 71.4% of urban HDs provided any adolescent-specific services, but fewer rural HDs (30.2%) provided onsite services than urban HDs (59.3%) (p=0.003). Fewer than half of rural (42.2%) and urban (48.8%) FQHCs provided adolescent-specific services, with approximately 23.8% of rural and 27.9% of urban sites providing onsite services. Conclusions: The capacity of clinics in SC and AL to provide contraceptive counseling to adolescents, which is anchored in reproductive autonomy, is contingent upon the provision of adolescent-specific services and provider training. Most clinics, especially rural clinics, did not have the capacity to provide patient-centered contraceptive counseling to adolescents. This gap in services may contribute to the higher adolescent pregnancy rates in rural areas of SC and AL. Clinics in SC and AL, especially FQHCs, should develop policies that support adolescent-specific contraceptive services and provider training