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Objectives: This study aimed to assess the association between insurance type and permanent contraception fulfillment among those with cesarean deliveries. Additionally, we sought to examine modification by the scheduled status of the cesarean. Study Design: We used data from a multi-site cohort study of patients who delivered in 2018–2019 at Northwestern Memorial Hospital in Illinois, MetroHealth Medical System in Ohio, or University of Alabama at Birmingham in Alabama. All patients had permanent contraception as their contraceptive plan in their medical chart during delivery hospitalization. We used logistic regression to model the association between insurance type, scheduled status of cesarean and permanent contraception fulfillment by hospital discharge. The scheduled status of cesarean delivery was examined as an effect modifier. Results: Compared to patients with private insurance, those with Medicaid were less likely to have their desired permanent contraception procedure fulfilled by hospital discharge (89.3% vs. 96.8%, p < 0.001). After adjusting for covariates, patients with Medicaid had a lower odds of permanent contraception fulfillment by hospital discharge (OR: 0.41; 95% CI: 0.21, 0.77). This association was stronger among those who had unscheduled cesarean deliveries (OR: 0.29; 95% CI: 0.12, 0.74) than those with scheduled cesarean deliveries (OR: 0.77; 95% CI: 0.32, 1.88). Conclusions for Practice: Compared to patients with private insurance undergoing a cesarean delivery, those with Medicaid insurance were less likely to have their desired permanent contraception fulfilled. Physicians and hospitals must examine their practices surrounding Medicaid forms to ensure that patients have valid consent forms available at the time of delivery. Significance: What is already known about this subject?: Studies have shown that the Medicaid sterilization consent process is associated with decreased fulfillment of desired postpartum permanent contraception. Cesarean delivery is one of the strongest predictors of permanent contraception fulfillment. What this study adds?: This study found that Medicaid is associated with decreased permanent contraception fulfillment in a subset of patients who had cesarean deliveries in a national multi-center cohort. These associations were particularly strong among patients who had unscheduled, compared to scheduled, cesarean deliveries. [ABSTRACT FROM AUTHOR]

Background: Barriers exist for the provision of surgery for permanent contraception in the postpartum period. Prenatal counseling has been associated with increased rates of fulfillment of desired postpartum contraception in general, although it is unclear if there is impact on permanent contraception specifically. Thus, we aimed to investigate the association between initial timing for prenatal documentation of a contraceptive plan for permanent contraception and fulfillment of postpartum contraception for those receiving counseling. Methods: This is a planned secondary analysis of a multi-site cohort study of patients with documented desire for permanent contraception at the time of delivery at four hospitals located in Alabama, California, Illinois, and Ohio over a two-year study period. Our primary exposure was initial timing of documented plan for contraception (first, second, or third trimester, or during delivery hospitalization). We used univariate and multivariable logistic regression to analyze fulfillment of permanent contraception before hospital discharge, within 42 days of delivery, and within 365 days of delivery between patients with a documented plan for permanent contraception in the first or second trimester compared to the third trimester. Covariates included insurance status, age, parity, gestational age, mode of delivery, adequacy of prenatal care, race, ethnicity, marital status, and body mass index. Results: Of the 3103 patients with a documented expressed desire for permanent contraception at the time of delivery, 2083 (69.1%) had a documented plan for postpartum permanent contraception prenatally. After adjusting for covariates, patients with initial documented plan for permanent contraception in the first or second trimester had a higher odds of fulfillment by discharge (aOR 1.57, 95% C.I 1.24–2.00), 42 days (aOR 1.51, 95% C.I 1.20–1.91), and 365 days (aOR 1.40, 95% C.I 1.11–1.75), compared to patients who had their first documented plan in the third trimester. Conclusions: Patients who had a documented prenatal plan for permanent contraception in trimester one and two experienced higher likelihood of permanent contraception fulfillment compared to those with documentation in trimester three. Given the barriers to accessing permanent contraception, it is imperative that comprehensive, patient-centered counseling and documentation regarding future reproductive goals begin early prenatally. Plain language summary: Permanent contraception is a highly desired form of postpartum contraception in the United States, however there are several barriers to accessing it. In this paper, we investigate whether the timing of when a patient has a documented plan for postpartum contraception has an impact on if they achieve postpartum contraception. This is a cohort study from four hospitals in Illinois, Ohio, California, and Alabama for patients with a desire for postpartum permanent contraception documented in their medical record. We specifically investigated the trimester (first, second, or third) where a patient had a plan for permanent contraception first documented. We then used univariate and multivariate models to determine the relationship between the timing of a plan for permanent contraception and if a patient achieved the procedure at three time-points: hospital discharge, 42-days, and 365-days. Our findings showed that of the 3103 patients in our cohort, only 69.1% of them had a documented plan for postpartum contraception at any point before going to the hospital for their delivery admission. We additionally found that patients who had a documented plan for permanent contraception in the first or second trimester had a higher odds of receiving their postpartum contraception procedure compared to people who had their first documented plan in the third trimester. This showed us the importance of earlier counseling regarding contraception for pregnant patients. There are many barriers to accessing postpartum contraception, so having patient focused counseling about future goals around reproductive health early on in pregnancy is critical. [ABSTRACT FROM AUTHOR]

Many of the nearly six million autistic adolescents and adults in the United States require support to navigate daily life. Family members often provide the first line of support for autistic youth by providing care and coordinating services. Although considerable research has examined the perspectives of family members caring for young autistic children, comparatively less has focused on those caring for transition-age youth who often struggle to access needed services as they leave child-serving systems of care. This study examined caregiver-reported barriers to service for 174 adolescents and young adults on the spectrum (ages 16–30) and the association between such barriers and unmet service needs. Exploratory factor analysis suggested two service barrier domains: access (e.g., cost) and quality (e.g., providers not trained). Regression models indicated that caregivers whose youth were diagnosed at older ages perceived both greater access and quality barriers. Male caregivers reported fewer access barriers, and those who perceived greater caregiver burdens (daily life disruptions, financial difficulties, and worries) reported more access barriers. Caregivers whose youth lived with them reported fewer quality barriers. Greater access–but not quality–service barriers predicted greater unmet service needs. Findings have implications for service delivery to autistic youth and specific directions for future research. Prior studies have described the roadblocks, or barriers, to needed services experienced by families with young autistic children, but less research has focused on those faced by autistic adolescents and young adults. In this study, we wished to understand the barriers to service experienced by autistic adolescents and young adults and their families. We surveyed 174 caregivers of autistic youth between 16 to 30 years old. We found that caregivers who felt more caregiving burden had more difficulty accessing services for their youth. Specifically, caregivers who felt more strongly that their daily lives had been disrupted, felt more financial strain, and worried more about their youth well-being experienced more roadblocks to getting services for the youth. Male caregivers also reported fewer difficulties related to service access. Importantly, the older the youth was when they had been diagnosed with autism, the more service barriers their caregivers reported. We did not see any differences in the level of barriers experienced by youth who lived in urban versus suburban settings, or between white and non-white families. However, when youth lived with their caregivers (rather than, for example, in a group home), fewer quality-related barriers to services were reported. Finally, greater access (but not quality) barriers were linked to youth having more unmet service needs. These findings can help to reduce the barriers to service experienced by autistic adolescents and young adults and their families. [ABSTRACT FROM AUTHOR]

Background: Evidence on the effects of neighborhood socioeconomic disadvantage on dementia risk in racially and ethically diverse populations is limited. Our objective was to evaluate the relative extent to which neighborhood disadvantage accounts for racial/ethnic variation in dementia incidence rates. Secondarily, we evaluated the spatial relationship between neighborhood disadvantage and dementia risk. Methods: In this retrospective study using electronic health records (EHR) at two regional health systems in Northeast Ohio, participants included 253,421 patients aged >60 years who had an outpatient primary care visit between January 1, 2005 and December 31, 2015. The date of the first qualifying visit served as the study baseline. Cumulative incidence of composite dementia outcome, defined as EHR‐documented dementia diagnosis or dementia‐related death, stratified by neighborhood socioeconomic deprivation (as measured by Area Deprivation Index) was determined by competing‐risk regression analysis, with non‐dementia‐related death as the competing risk. Fine‐Gray sub‐distribution hazard ratios were determined for neighborhood socioeconomic deprivation, race/ethnicity, and clinical risk factors. The degree to which neighborhood socioeconomic position accounted for racial/ethnic disparities in the incidence of composite dementia outcome was evaluated via mediation analysis with Poisson rate models. Results: Increasing neighborhood disadvantage was associated with increased risk of EHR‐documented dementia diagnosis or dementia‐related death (most vs. least disadvantaged ADI quintile HR = 1.76, 95% confidence interval = 1.69–1.84) after adjusting for age and sex. The effect of neighborhood disadvantage on this composite dementia outcome remained after accounting for known medical risk factors of dementia. Mediation analysis indicated that neighborhood disadvantage accounted for 34% and 29% of the elevated risk for composite dementia outcome in Hispanic and Black patients compared to White patients, respectively. Conclusion: Neighborhood disadvantage is related to the risk of EHR‐documented dementia diagnosis or dementia‐related death and accounts for a portion of racial/ethnic differences in dementia burden, even after adjustment for clinically important confounders. [ABSTRACT FROM AUTHOR]

Intimate partner violence (IPV) exposure threatens healthy child development by compromising outcomes across a range of domains including academic functioning. However, research suggests variability in the strength and nature of the association between IPV exposure and academic functioning, and the extent to which it varies by different academic outcomes and co-occurring risk factors (e.g., child maltreatment). This systematic review seeks to clarify the relation between IPV exposure and academic functioning by distilling overall outcome trends and critically assessing the existing literature's strengths and limitations. Seven databases were searched to identify relevant articles published through August 2020. Studies were included if (a) at least 80% of the sample were from birth to 18 years of age; (b) valid tools were used to measure outcome variables, and (c) outcomes of children exposed to IPV were compared with children who experienced other forms of violence and/or no violence exposure. After screening, the review yielded 13 articles examining academic functioning. The majority (76.9%, n = 10) of the studies found a negative association between IPV exposure and academic functioning, but results varied among subdomains of academic functioning (subjective performance, objective performance, and conduct). Findings from several studies indicate that the combined experience of IPV exposure and maltreatment negatively affects academic functioning. Results highlight the need for: 1) additional research examining IPV exposure and academic functioning 2) early detection of IPV-exposed children, and 3) the development and implementation of evidence-based interventions to support academic functioning. [ABSTRACT FROM AUTHOR]

An estimated 15.5 million children in the United States are exposed to intimate partner violence (IPV) in their homes each year. Empirical data suggest that childhood IPV exposure is associated with a plethora of adverse outcomes such as poor behavioral regulation, reduced cognitive functioning, and greater aggressive behavior. Within this body of research, it has been suggested that IPV-exposed children are more likely to both perpetrate and fall victim to bullying than non-exposed children. This systematic review explores the relationship between IPV exposure and bullying perpetration and victimization in the existing literature and includes a discussion of individual- and family-level factors that have been considered in the association between IPV exposure and bullying perpetration and victimization. Building upon findings from a broader Evidence and Gap Map, this systematic literature review identified 14 articles that examined the association between IPV exposure and bullying perpetration and victimization. Of these 14 articles, 12 assessed the relationship between youth IPV exposure and bullying perpetration, and 75.0% of these articles (n = 9) found a significant relationship between IPV exposure and bullying perpetration. Ten of the 14 articles examined youth IPV exposure and bullying victimization, with 70.0% of the articles (n = 7) supporting this association. Individual- and broader family-level characteristics, including gender, race/ethnicity, mental health symptoms, other types of adversities, and parenting were also examined. The article addresses implications for research and practice, including methodological suggestions for future studies and avenues for potential intervention for IPV-exposed children experiencing bullying victimization and perpetration. [ABSTRACT FROM AUTHOR]

Research suggests that police encounters can be a traumatic experience for youth. These experiences may result in trauma symptomatology and co-occurring mental health issues like depression and anxiety. However, studies exploring the relationships between trauma symptomatology, depression and anxiety do not typically focus on trauma that is rooted in experiences with the police. The present study utilizes exploratory and confirmatory factor analysis to examine the relationships among police-initiated post-traumatic stress symptoms, depression and anxiety. Exploratory and confirmatory factor analysis examines the factor structure of police-initiated post-traumatic stress symptoms, depression and anxiety. Results suggest that police-initiated post-traumatic stress symptomatology is two factors that are distinguishable from anxiety and depression. Our findings highlight the need to develop methods of disentangling the relationships between police-initiated post-traumatic stress symptomatology and co-occurring mental health symptoms, and advocating for policies and practices that can reduce negative police-youth interactions. [ABSTRACT FROM AUTHOR]

Firearm-related violence is a significant threat to public health and safety in America. However, research highlights a critical disparity in firearm-related deaths by race. Researchers often cite racial bias as a contributing factor for the racial disparity in firearm-related deaths. To provide a foundation for potential social work interventions, the present article discusses the results of an assessment of whether explicit racial biases toward four racial and ethnic groups (white, black, Asian, Hispanic/Latino), fear of crime, and the quantity and quality of interactions with neighbors of a different race are predictors of gun ownership. Findings suggest that explicit racial bias toward black, Asian, and Hispanic/Latino individuals is a significant predictor of gun ownership. Fear of crime and more frequent interactions with neighbors of a different race are also significant predictors of gun ownership. Taken as a whole, findings suggest that gun owners are more likely to be more vigilant toward people of color because of stereotypical assumptions that racial and ethnic minorities are more likely to be involved with crime. Social work practice and policy implications include developing interventions aimed at reducing implicit bias and identifying policies that are associated with lower levels of implicit bias among gun owners. [ABSTRACT FROM AUTHOR]