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Rates of sexually transmitted infections (STIs) among adolescents and young adults (15-24) continue to increase. Limited national information exists about the frequency and source of STI testing among this population.We performed a cross-sectional analysis of National Survey of Family Growth data from 2013-2019 to describe patterns in STI testing and assess associations with individual characteristics.We found that non-Hispanic Black women, non-Hispanic Black and Hispanic men, and individuals with public insurance are more likely to receive an STI test. The two sexes have different sources of care for STI testing and publicly supported providers provide the bulk of services to marginalized populations.STI testing frequencies of this age group fall below what national guidelines suggest. Multiple socioecological factors may affect the likelihood that a young person receives an STI test. All providers should be supported and encouraged to provide confidential and unbiased STI care.

Abortion is a difficult-to-measure behaviour with extensive underreporting in surveys, which compromises the ability to study and monitor it. We aimed to improve understanding of how women interpret and respond to survey items asking if they have had an abortion. We developed new questions hypothesised to improve abortion reporting, using approaches that aim to clarify which experiences to report; reduce the stigma and sensitivity of abortion; reduce the sense of intrusiveness of asking about abortion; and increase respondent motivation to report. We conducted cognitive interviews with cisgender women aged 18-49 in two US states (

Objectives. To investigate trends in the use and quality of telehealth for contraceptive care during the COVID-19 pandemic in the United States. Methods. The 2021 Guttmacher Survey of Reproductive Health Experiences is a national online survey of 6211 people assigned female at birth, aged 18 to 49 years, and that ever had penile‒vaginal sex. We used weighted bivariable and multivariable logistic regressions to analyze the use of telehealth for contraceptive care and the quality of this care. Results. Of the respondents, 34% received a contraceptive service in the 6 months before the survey; of this group, 17% utilized telehealth. Respondents who were uninsured at some point in the 6 months before the survey had greater odds of using telehealth for this care. Respondents had lower odds of rating the person-centeredness of their care as “excellent” if they received services via telehealth compared with in person (25% vs 39%). Conclusions. Telehealth has helped bridge gaps in contraceptive care deepened by COVID-19. More work is needed to improve the quality of care and reduce access barriers to ensure telehealth can meet its full potential as part of a spectrum of care options. (Am J Public Health. 2022;112(S5):S545–S554. https://doi.org/10.2105/AJPH.2022.306886 )

Progression-free survival and hazard ratios by histology

Purpose:Advanced-stage endometrial cancers have limited treatment options and poor prognosis, highlighting the need to understand genetic drivers of therapeutic vulnerabilities and/or prognostic predictors. We examined whether prospective molecular characterization of recurrent and metastatic disease can reveal grade and histology-specific differences, facilitating enrollment onto clinical trials.Experimental Design:We integrated prospective clinical sequencing and IHC data with detailed clinical and treatment histories for 197 tumors, profiled by MSK-IMPACT from 189 patients treated at Memorial Sloan Kettering Cancer Center.Results:Patients had advanced disease and high-grade histologies, with poor progression-free survival on first-line therapy (PFS1). When matched for histology and grade, the genomic landscape was similar to that of primary untreated disease profiled by TCGA. Using multiple complementary genomic and mutational signature-based methods, we identified patients with microsatellite instability (MSI), even when standard MMR protein IHC staining failed. Tumor and matched normal DNA sequencing identified rare pathogenic germline mutations in BRCA2 and MLH1. Clustering the pattern of DNA copy-number alterations revealed a novel subset characterized by heterozygous losses across the genome and significantly worse outcomes compared with other clusters (median PFS1 9.6 months vs. 17.0 and 17.4 months; P = 0.006). Of the 68% of patients harboring potentially actionable mutations, 27% were enrolled to matched clinical trials, of which 47% of these achieved clinical benefit.Conclusions:Prospective clinical sequencing of advanced endometrial cancer can help refine prognosis and aid treatment decision making by simultaneously detecting microsatellite status, germline predisposition syndromes, and potentially actionable mutations. A small overall proportion of all patients tested received investigational, genomically matched therapy as part of clinical trials.

Additional clinical information for patients in MSKCC cohort

Supplementary Table and Figure Legends

Expectations to share data underlying studies are increasing, but research on how participants, particularly those in qualitative research, respond to requests for data sharing is limited. We studied research participants’ willingness to, understanding of, and motivations for data sharing. As part of a larger qualitative study on abortion reporting, we conducted interviews with 64 cisgender women in two states in early 2020 and asked for consent to share de-identified data. At the end of interviews, we asked participants to reflect on their motivations for agreeing or declining to share their data. The vast majority of respondents consented to data sharing and reported that helping others was a primary motivation for agreeing to share their data. However, a substantial number of participants showed a limited understanding of the concept of “data sharing.” Additional research is needed on how to improve participants’ understanding of data sharing and thus ensure fully informed consent.

Abortions are substantially underreported in surveys due to social stigma, compromising the study of abortion, pregnancy, fertility, and related demographic and health outcomes.In this study, we evaluated six methodological approaches identified through formative mixed-methods research to improve the measurement of abortion in surveys. These approaches included altering the placement of abortion items in the survey, the order of pregnancy outcome questions, the level of detail, the introduction to the abortion question, and the context of the abortion question, and using graduated sensitivity. We embedded a preregistered randomized experiment in a newly designed online survey about sexual and reproductive health behaviors (N = 6536). We randomized respondents to experimental arms in a fully crossed factorial design; we estimated an average treatment effect using standardized estimators from logistic regression models, adjusted for demographic covariates associated with reporting.None of the experimental arms significantly improved abortion reporting compared to the control condition.More work is needed to improve reporting of abortion in future surveys, particularly as abortion access becomes increasingly restricted in the United States. Despite this study's null results, it provides a promising path for future efforts to improve abortion measurement. It is proof of concept for testing new approaches in a less expensive, faster, and more flexible format than embedding changes in existing national fertility surveys.

The COVID-19 pandemic abruptly disrupted the provision of sexual and reproductive health care in the United States.We conducted interviews with family planning clinic staff at 55 health care facilities in Arizona, Iowa, and Wisconsin in late 2020 and early 2021. We asked respondents about the challenges they faced and ways they adapted their service provision as a result of the pandemic. We conducted content and thematic analyses of the interview transcripts using an inductively developed qualitative coding scheme.Family planning clinics and providers made a variety of changes to their clinic operations and service delivery. The three major areas of change for these facilities were implementation of COVID-19 safety procedures, shifting service delivery and staffing to meet patient needs, and the rapid uptake and expansion of telehealth.While providers faced many challenges, they also described opportunities to innovate and rethink standard of care protocols that may continue to shape sexual and reproductive health care even after the pandemic abates.

Background: Abortion is a difficult-to-measure behavior with extensive survey underreporting, which compromises the ability to study and monitor abortion. The purpose of this study was to improve our understanding of how women interpret and respond to survey items asking if they have ever had an abortion. Methods: We developed multiple new questions hypothesized to improve abortion reporting, using approaches that aim to clarify which experiences to report as an induced abortion; reduce the stigma and sensitivity of induced abortion; reduce the sense of intrusiveness of asking about abortion; and increase the motivation to report. We conducted cognitive interviews with cisgender women aged 18-49 in two US states (N=64) to iteratively assess these new approaches and questions for improving abortion reporting. Results: Our findings suggest that including abortion as part of a list of other sexual and reproductive health services, asking a yes/no question about lifetime experience of abortion instead of asking about number of abortions, and developing an improved introduction to abortion questions may help to elicit more accurate survey reports. Conclusions: Opportunities exist to improve survey measurement of abortion. Reducing underreporting of abortion in surveys has the potential to improve sexual and reproductive health research that relies on pregnancy histories.

Past research on gender-based violence (GBV) in Pakistan discusses intimate partner violence (IPV) and non-partner sexual violence (NPSV) but lacks a comprehensive analysis of violence against women and girls (VAWG) and its wider costs and impacts. Our study on the social costs of VAWG aims to fill this gap. Through in-depth interviews (IDIs) and focus group discussions (FGDs) in rural and urban Pakistan, we explore the types of VAWG that manifest in communities and examine the negative impacts these have on survivors, their families and communities. Our findings reveal that, in addition to the mental health impacts of VAWG on survivors (such as anxiety and suicidal ideation exacerbated by stigma and isolation), a number of social and economic impacts are borne by survivors as well as their relatives and communities. Social norms and institutions that condone and reproduce gender inequity contribute to the acceptance and normalization of VAWG. Lack of service provision and shelter for survivors and social stigma around seeking help heightens the impacts faced by survivors, their families and their communities.

In this report, we analyze the 2021 data, focusing on how respondents feel the COVID-19 pandemic has influenced their sexual and reproductive health in two core areas: fertility preferences and access to care, including use of telehealth. We note disparities according to individuals’ race and ethnicity, sexual orientation, gender identity, income level and economic well-being. To assess the ongoing scope and magnitude of the impacts of the pandemic, we also examine findings on comparable measures from the 2020 and 2021 GSRHE studies. These data provide four key findings: The pandemic has continued to shift fertility preferences and impede access to sexual and reproductive health care, including contraceptive services. The impacts reported in the summer of 2021 are smaller than those reported earlier in the pandemic but remain pervasive. The pandemic continues to have disproportionate effects on the sexual and reproductive health of those already experiencing systemic social and health inequities. Telehealth services are bridging gaps in sexual and reproductive health care resulting from pandemic-related upheaval, particularly for those who already experience barriers to accessing health care.

Key Points Seven in 10 U.S. women of reproductive age, some 44 million women, make at least one medical visit to obtain sexual and reproductive health (SRH) services each year. While the overall number of women receiving any SRH service remained relatively stable between 2006–2010 and 2015–2019, the number of women receiving preventive gynecologic care fell and the number receiving STI testing doubled. Disparities in use of SRH services persist, as Hispanic women are significantly less likely than non-Hispanic White women to receive SRH services, and uninsured women are significantly less likely to receive services than privately insured women. Publicly funded clinics remain critical sources of SRH care for many women, with younger women, lower income women, women of color, foreign-born women, women with Medicaid coverage and women who are uninsured especially likely to rely on publicly funded clinics. Among women who go to clinics for SRH care, two-thirds report that the clinic is their usual source for medical care. Among those relying on both private providers and public clinics, the proportion of women who reported receiving a combination of contraceptive and STI/HIV care increased between 2006–2010 and 2015–2019. Implementation of the Affordable Care Act has likely contributed to some of the changes observed in where women receive contraceptive and other SRH services and how they pay for that care: The share of women receiving contraceptive services who go to private providers rose from 69% to 77% between 2006–2010 and 2015–2019, in part because more women gained private or public health insurance coverage and there was a greater likelihood that their health insurance would cover SRH services. There was a complementary drop in the share of women receiving contraceptive services who went to a publicly funded clinic, from 27% in 2006–2010 to 18% in 2015–2019. For non-Hispanic Black women, immigrant women and uninsured women, there was no increase in the use of private providers for contraceptive care from 2006–2010 to 2015–2019. Among women served at publicly funded clinics between 2006–2010 and 2015–2019, there were significant increases in the use of both public and private insurance to pay for their care.

Infection or vaccination leads to the development of germinal centers (GCs) where B cells evolve high affinity antigen receptors, eventually producing antibody-forming plasma cells or memory B cells. We followed the migratory pathways of B cells emerging from germinal centers (BEM) and found that many migrated into the lymph node subcapsular sinus (SCS) guided by sphingosine-1-phosphate (S1P). From there, B cells may exit the lymph node to enter distant tissues. Some BEM cells interacted with and took up antigen from SCS macrophages, followed by CCL21-guided return towards the GC. Disruption of local CCL21 gradients inhibited the recycling of BEM cells and resulted in less efficient adaption to antigenic variation. Our findings suggest that the recycling of BEM cells, that transport antigen and that contain the genetic code for B cell receptor variants, may support affinity maturation to antigenic drift.