Accessibility of Federally Funded Family Planning Services in South Carolina and Alabama

This study operationalized the five dimensions of health care access in the context of contraceptive service provision and used this framework to examine access to contraceptive care at health department (HD) (Title X funded) and federally qualified health center (FQHC) (primarily non-Title X funded) clinics in South Carolina and Alabama. A cross-sectional survey was conducted in 2017/18 that assessed clinic-level characteristics, policies, and practices related to contraceptive provision. Provision of different contraceptive methods was examined between clinic types. Survey items were mapped to the dimensions of access and internal consistency for each scale was tested with Cronbach\u27s alpha. Scores of access were developed and differences by clinic type were evaluated with an independent t-test. The overall response rate was 68.3% and the sample included 235 clinics. HDs (96.9%) were significantly more likely to provide IUDs and/or Impants on-site than FQHCs (37.4%) (P \u3c 0.0001). Scales with the highest consistency were Availability: Clinical Policy (24 items) (alpha = 0.892) and Acceptability (43 items) (alpha = 0.834). HDs had higher access scores than FQHCs for the Availability: Clinical Policy scale (0.58, 95% CL 0.55, 0.61) vs (0.29, 95% CL 0.25, 0.33) and Affordability: Administrative Policy scale (0.86, 95% CL 0.83, 0.90) vs (0.47, 95% CL 0.41, 0.53). FQHCs had higher access scores than HDs for Affordability: Insurance Policy (0.78, 95% CL 0.72, 0.84) vs (0.56, 95% CL 0.53, 0.59). These findings highlight strengths and gaps in contraceptive care access. Future studies must examine the impact of each dimension of access on clinic-level contraceptive utilization

Role of Individual, Family, and Community Resilience in Moderating Effects of Adverse Childhood Experiences on Mental Health Among Children

OBJECTIVE: Mental health outcomes such as attention-deficit/hyperactivity disorder (ADHD), behavior disorders, anxiety, depression, and adverse childhood experiences (ACEs) are common disorders among children in the United States. Little is known on how potential resilient factors may moderate the relationship between exposure to ACEs and mental health outcomes. This study examines associations between ACEs and resilience on mental health outcomes using the 2018 National Survey of Children\u27s Health (N = 26,572). METHOD: Logistic regression and interactions examined the association between ACEs, resilience, and mental health outcomes. ACE exposure and low resiliency were associated with an increased likelihood of mental health outcomes. RESULTS: There were significant interactions between exposure to ACEs and family resilience as well as significant interactions between ACE exposure and community resilience. On stratification, the presence of individual resilience and having all resilience measures decreased the odds of ADHD, behavioral disorders, anxiety, and depression and the presence of community resilience decreased the odds of depression among individuals who had experienced 4 or more ACEs. CONCLUSION: These results illustrate the need to promote resilience measures for tackling mental health problems and reducing the negative effect of trauma in children

Adverse Childhood Experiences (ACES): Assessing Their Impact on Mental Health Outcomes Among US Children and the Mitigating Role of Resilience

ACEs are traumatic life events occurring during childhood that can have negative effects. Common mental disorders that are diagnosed in childhood are attention-deficit/hyperactivity disorder (ADHD), behavior disorders, anxiety and depression. The associations between ACEs and such problems in children have not been significantly examined. There are protective factors that can help reduce the effects of exposure to ACEs that have not been fully explored. The purpose of this research study was to examine: 1) the prevalence of mental health outcomes in children; 2) the associations between ACEs, resilience and mental health outcomes; and 3) the role of resiliency as a moderating variable between ACEs and mental health outcomes. A secondary data analysis utilizing data from the 2018 National Survey of Children’s Health (NSCH) was used to examine the proposed aims. The study population consisted of children between the ages of 3 and 17. Chi-square analyses were utilized, and logistic regression models were constructed. Weighted prevalence estimates were calculated. 8.6%, 6.9%, 8.0% and 3.7% currently had ADHD, behavioral disorders, anxiety and depression. The prevalence of each disorder was higher for older age, Whites, public insurance, single parent homes or homes without parents, caregivers with mental health problems and non-users of medical home. Children exposed to 4 or more ACEs had greater odds of ADHD (adjusted odds ratio [aOR]= 2.03; 95% confidence interval [CI], 1.52-2.72), behavioral disorders (aOR: 2.47; CI: 1.81-3.37), anxiety (aOR: 2.66; CI: 2.00-3.53) and the strongest relationship was seen with depression (aOR: 4.53; CI: 3.13-6.54). Individual resilience, family resilience and community resilience were associated with decreased odds of mental health outcomes and the strongest relationship was seen with individual resilience. There were significant interactions between exposure to ACEs and child resilience for ADHD (aOR: 0.14; CI: 0.08-0.23), current behavioral disorders (aOR: 0.10; CI: 0.06-0.16), anxiety and (aOR: 0.21; CI: 0.13-0.35) depression (aOR: 0.24; CI: 0.13-0.43) as well as significant interactions between ACE exposure and community resilience for depression (aOR: 0.25; CI: 0.10-0.61). The findings of this research have implications for the improvement of mental health diagnosis, promotion of resilient measures and future research

Relationship between Adverse Childhood Experiences and Resiliency among College Students

Background: Adverse childhood experiences (ACEs) are associated with negative outcomes, however, there are factors that can mitigate the effects from exposure to ACEs. This study examined the prevalence of adverse childhood experiences (ACEs), characteristics of resilient individuals and the association between ACE scores, resiliency and other factors among college students

Prevalence and Correlates of Mental Health Disorders Among Children &Amp; Adolescents in U.S.

The purpose of this study was to determine the national prevalence and correlates of currently diagnosed attention deficit/hyperactivity disorder (ADHD), behavioral problems, anxiety and depression among U.S. children aged 3–17 years. Data from the 2018 National Survey of Children\u27s Health (NSCH) was analyzed. Parents/caregivers reported whether their children currently had each mental health condition. Chi square analyses and multivariate logistic regressions were utilized to examine the prevalence of conditions and assess independent associations based on selected sociodemographic characteristics. Weighted prevalence estimates were calculated for the study population (n = 26,572). The study found that 8.6% currently had ADHD, 6.9% currently had behavioral disorders, 8.0% currently had anxiety, 3.7% currently had depression and 16.1% had any of the four conditions. The prevalence of each disorder was higher for older age, Whites (except for behavioral disorders which were higher for Blacks), public insurance, single parent households, children living with non-parents, parent/caregiver mental/emotional health, and non-users of medical home when comparing individuals who had these disorders to those without the disorders. Condition-specific variations were observed. Children with public and private insurance, single parents/non-parents, mentally ill parents and not receiving care in a medical home were more likely to be diagnosed with mental health disorders. These findings provide the latest data on a broad range of mental health disorders in a nationally representative sample of U.S. children and adolescents and show that these problems are prevalent which highlight the need for prevention and early intervention

Health Care Burden and Expenditure Associated with Adverse Childhood Experiences in Tennessee and Virginia

To estimate attributable burden and costs of conditions associated with exposure to Adverse Childhood Experiences (ACEs) in Tennessee (TN) and Virginia (VA) during 2017. This is a cross-sectional study of individuals aged 18+ having exposure to ACEs using Behavioral Risk Factor Surveillance System (BRFSS) data. Eight chronic diseases (asthma, obesity, hypertension, diabetes, chronic obstructive pulmonary disease (COPD), depression, cardiovascular disease, and arthritis) and two risk factors (smoking and drinking) associated with ACEs were analyzed. Pearson\u27s chi-square tests analyzed the association between ACEs, risk factors and chronic diseases. The population attributable risks (PAR) were estimated for the ACEs related diseases and risk factors and combined with health care expenses and Disability Adjusted-Life-Years (DALYs). Among those who experienced at least 1 ACE in TN, 10% had COPD, 17% had diabetes, 36% had obesity, and 30% had depression. Individuals who experienced at least 1 ACE in VA had higher percentages for COPD, obesity and depression diseases compared to those who had no ACE (p\u3c.0001). ACEs’ exposure resulted in a burden of about 115,000 years and 127,000 years in terms of DALYs in TN and VA, respectively. The total health spending associated with ACEs based on PARs was about $647 million ($165 per adult) and $942 million ($292 per adult) in TN and VA respectively. The total costs associated with ACEs was about $15.5 billion ($3948) per person) and $20.2 billion ($6288 per person) in TN and VA, respectively. This study emphasizes the need to reduce ACEs due to high health and financial costs

Geographic Differences in Contraception Access and Utilization Within Family Planning Organizations in South Carolina

Introduction: Unintended pregnancies are associated with poor health and economic outcomes. The use of modern contraceptive methods has been proven to be effective in reducing unintended pregnancy. Historical barriers in access to care experienced by rural communities suggest that rural women may also experience barriers in accessing reproductive health services. However, little is known about geographic variation in reproductive health services. The primary aim of this study is to examine rural and urban differences in access to and utilization of contraceptive methods among publicly funded clinics in South Carolina. Methods: A cross-sectional study of all Federally Qualified Health Center (FQHC) and Department of Health & Environmental Control (DHEC) family planning clinics in South Carolina offering reproductive health services in 2017 was used to examine access to and utilization of contraceptive methods. Administrators or organizational representatives with knowledge of clinic operations were asked to complete a survey specific to the provision of contraceptive services. Two outcomes from the survey were of primary interest. Access to a full range of contraceptive methods was operationalized as a dichotomous variable reflecting whether or not an individual method was directly available on-site. Utilization was defined as the percent of women using individual methods, relative to the overall distribution of women receiving contraceptive services. The Rural-Urban Continuum Codes (RUCC) were used to categorize clinic as rural or urban. RUCC codes 1, 2 and 3 were classified as urban, while codes 4 through 8 were classified as rural. Contraceptive methods were examined individually and aggregated into 3 groups: highly effective reversible methods, moderately effective methods and least effective methods. Bivariate relationships between the two-level RUCC variable and provision of contraceptive methods were examined using a Chi-square test for independence. An independent t-test was also used to examine differences in contraceptive utilization based on rural or urban clinic designation. Results: The study population consisted of 105 clinics, with 60% of clinics in urban areas and 40% in rural areas. Across the state of South Carolina, 75% of clinics offer highly effective contraceptive methods without having to schedule a follow-up visit to receive the method. Although not statistically significant, among clinics that offered highly effective reversible contraceptives on site, 79% of such methods are available in urban communities compared to 74% in rural and communities (p=0.49). About 12% of women at urban clinics utilized highly effective reversible methods compared to 7% of women at rural clinics (p=0.02). This appears to be driven by less access to and utilization of hormonal implants (9% among urban clinics compared to 5% among rural). Conclusion: Access to highly effective methods through publicly funded providers is similar in rural and urban communities; however, rural/urban differences in the utilization of highly effective methods, specifically implants, was noted. Given historical disparities in access and transportation barriers among rural population, decreased access and utilization of methods that allow for longer durations between provider visits could be problematic. These findings suggest that increased efforts ensuring access to long acting reversible contraception in rural clinics is warranted

Health Care Burden and Expenditure Associated with Adverse Childhood Experiences in Tennessee and Virginia

Introduction: Adverse childhood experiences (ACEs) have been considered a significant risk factor for poorer adult outcomes. Considering the studies linking ACEs to chronic diseases in adulthood as well as the increasing prevalence for these chronic conditions, exposure to childhood traumas represents a significant economic burden in the United States which has not been explored. This study provides the first examination of the attributable burden and costs of conditions associated with exposure to ACEs in Tennessee (TN) and Virginia (VA) during 2017. Methods: This is a cross-sectional study of individuals aged 18+ having exposure to ACEs using Behavioral Risk Factor Surveillance System (BRFSS) data for TN and VA in 2017. Eight chronic diseases (asthma, obesity, hypertension, diabetes, chronic obstructive pulmonary disease (COPD), depression, cardiovascular disease, and arthritis ) and two risk factors (smoking and drinking ) associated with ACEs were analyzed. Pearson\u27s chi-square tests analyzed the association between individuals exposed to ACEs and the risk factors with the chronic diseases. The population attributable risk (PAR) were estimated for the ACEs related diseases and risk factors. These estimates were combined with published estimates of health care expenses and Disability Adjusted-Life-Years (DALYs). Results: Among those who had experienced at least 1 ACE in TN, 10% had COPD, 17% had diabetes, 36% had obesity, and 30% had depression. Individuals who had experienced at least 1 ACE in VA had higher percentages for COPD, obesity and depression diseases compared to those who had no ACE (p\u3c .0001). ACEs exposure resulted in a burden of about 115,00 years and 125,000 years in terms of DALYs in TN and VA respectively. The total health spending associated with ACEs based on PARs was about $650 million ($158.15 per adult) and $942 million ($305.02 per adult) in TN and VA respectively. Depression accounted for the largest combined sum of health care spending (TN - $448,105,983, VA –$633,225,398). With DALYs valued at $235,855 in 2017 dollars, the monetized cost of DALYs attributable to ACEs was over$27 billion, $6615 per exposed adult Tennessean. The monetized loss due to DALYs represents over$30 billion (in 2017 dollars) , $9,737 per exposed adult in Virginia. Conclusions: This study emphasizes the need to reduce ACEs which can be utilized to inform interventions to reduce the impact of ACEs in Tennessee and Virginia. Medical conditions attributable to childhood traumas can result in increased utilization of hospital services, psychiatric care, as well as care related to chronic conditions, which includes increased primary and specialty care utilization as well as the cost of medications. While medical expenses represent a significant burden, reduced quality of life resulting from ACE attributable conditions also represents a burden in disability adjusted life years (DALYs) and premature morbidity. As resources are limited and the burden of ACEs shown here is very high, there is the need for a wide range of prevention and treatment strategies to mitigate these effects

Geographic Differences in Contraception Provision and Utilization Among Federally Funded Family Planning Clinics in South Carolina and Alabama

Purpose: Access to the full range of contraceptive options is essential to providing patient-centered reproductive health care. Women living in rural areas often experience more barriers to contraceptive care than women living in urban areas. Therefore, federally funded family planning clinics are important for ensuring women have access to contraceptive care, especially in rural areas. This study examines contraceptive provision, factors supporting contraceptive provision, and contraceptive utilization among federally funded family planning clinics in 2 Southern states. Methods: All health department and Federally Qualified Health Center clinics in Alabama and South Carolina that offer contraceptive services were surveyed in 2017-2018. Based on these surveys, we examined differences between rural and urban clinics in the following areas: clinic characteristics, services offered, staffing, staff training, policies, patient characteristics, contraceptive provision, and contraceptive utilization. Differences were assessed using Chi-square tests of independence for categorical variables and independent t-tests for continuous variables. Findings: Urban clinics had more staff on average than rural clinics, but rural clinics reported greater ease in recruiting and retaining family planning providers. Patient characteristics did not significantly vary between rural and urban clinics. While no significant differences were observed in the provision of long-acting reversible contraceptives (LARCs) overall, a greater proportion of patients in urban clinics utilized LARCs. Conclusions: While provision of most contraceptives is similar between rural and urban federally funded family planning clinics, important differences in other factors continue to result in women who receive care in rural clinics being less likely to choose LARC methods

Accessibility of federally funded family planning services in South Carolina and Alabama

This study operationalized the five dimensions of health care access in the context of contraceptive service provision and used this framework to examine access to contraceptive care at health department (HD) (Title X funded) and federally qualified health center (FQHC) (primarily non-Title X funded) clinics in South Carolina and Alabama. A cross-sectional survey was conducted in 2017/18 that assessed clinic-level characteristics, policies, and practices related to contraceptive provision. Provision of different contraceptive methods was examined between clinic types. Survey items were mapped to the dimensions of access and internal consistency for each scale was tested with Cronbach’s alpha. Scores of access were developed and differences by clinic type were evaluated with an independent t-test. The overall response rate was 68.3% and the sample included 235 clinics. HDs (96.9%) were significantly more likely to provide IUDs and/or Impants on-site than FQHCs (37.4%) (P < 0.0001). Scales with the highest consistency were Availability: Clinical Policy (24 items) (alpha = 0.892) and Acceptability (43 items) (alpha = 0.834). HDs had higher access scores than FQHCs for the Availability: Clinical Policy scale (0.58, 95% CL 0.55, 0.61) vs (0.29, 95% CL 0.25, 0.33) and Affordability: Administrative Policy scale (0.86, 95% CL 0.83, 0.90) vs (0.47, 95% CL 0.41, 0.53). FQHCs had higher access scores than HDs for Affordability: Insurance Policy (0.78, 95% CL 0.72, 0.84) vs (0.56, 95% CL 0.53, 0.59). These findings highlight strengths and gaps in contraceptive care access. Future studies must examine the impact of each dimension of access on clinic-level contraceptive utilization