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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's 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< .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.

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.

Highlights • Scores of access measure contraceptive care accessibility across five dimensions. • Differences in access exist between safety-net clinic type in South Carolina and Alabama. • Gaps within each dimension of access suggest data driven policy interventions., 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

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. Subjects and Method: A cross-sectional survey was completed in 2018. Frequencies were calculated for the number and types of ACE experienced by participants. Bivariate relationships between characteristics of parti­cipants and resilience were examined using Chi-square tests. The independent relationship between ACE scores and resiliency factors was examined using ordinal logistic regression. The dependent variable was ACE score. An ordinal logistic regression model examined the relati­onship between conventional ACE scores and resilience levels and other factors. Results: There were 570 study participants. Seventy-one percent of study participants had experienced at least one conventional ACE, and 98% had experienced at least one expanded ACE. Individuals with high resilience had lower conventional ACE scores and better health. Females (OR= 1.67; 95% CI= 1.14 to 2.45) were more likely to have higher conventional ACE scores. Participants living in suburban areas compared to rural areas (OR= 0.61; 95% CI: 0.43 to 0.85), and children raised with both parents compared to single parents (OR= 0.17; 95% CI= 0.12 to 0.25) were less likely to have higher conventional ACE scores. Gender (OR= 0.54; 95% CI= 0.35 to 0.82) and general health status (OR= 1.50; 95% CI= 1.05 to 2.13) were the only significant predictors of the expanded ACE scores. Conclusion: Findings identify important resilient traits such as relationships, self-control, internal beliefs, and initiative,. as well asportray the high prevalence ofACEs and the importance of resilience as a protective factor in reducing ACEs. Keywords: adverse childhood experiences, resilience, mitigate Correspondence : Glory Okwori. East Tennessee State University. 1276 Gilbreath Dr., Box 70300, Johnson City, TN. Email: okwori@etsu.edu. Journal of Epidemiology and Public Health (2021), 06(01): 83-97 https://doi.org/10.26911/jepublichealth.2021.06.01.09