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INTRODUCTION. Pregnant and postpartum women experience significant sleep disruption, but the role of perinatal sleep disturbances in breastfeeding is understudied. METHODS. In this observational cohort study, we used mixed methods to examine associations between perinatal sleep and breastfeeding. 48 women (mean age 28.2±4.9 years) who were euthymic at enrollment but had a history of major depression (n=43) or bipolar disorder (n=5) had sleep recorded with wrist actigraphy. We determined feeding status through daily diaries and used semi-structured interviews to identify themes regarding participants’ experiences, breastfeeding decisions, and behaviors. To examine whether sleep disturbance during pregnancy predicted breastfeeding (BF) rates, we defined “lower sleep efficiency” (LSE) and “higher sleep efficiency” (HSE) groups based on the median split of actigraphic SE at 33 weeks’ gestation (cutoff SE=84.9%) and classified mothers as No-BF, Mixed-BF (BF+formula), and Exclusive-BF at 2 weeks postpartum. RESULTS. Percentages of women who did any breastfeeding were: Week 2=72.3%, Week 6=62.5%, Week 16= 50%. LSE mothers were less likely than HSE mothers to initiate breastfeeding (percent No-BF: LSE=45.8%, HSE=16.7%, p

Purpose: The purpose of this study was to examine the extent to which transgender people have observed negative transgender-related messages in the media and the relationship between negative media message exposure and the mental health of transgender people. Methods: In 2019, 545 transgender adults completed an online survey assessing demographics, negative transgender-related media messages, violence, and mental health. Separate multivariable logistic regression models examined the association of frequency of negative media exposure and clinically significant symptoms of depression, anxiety, post-traumatic stress disorder (PTSD), and global psychological distress. Results: Mean age of the sample was 31.2 years (standard deviation [SD] = 11.2). Nearly half identified as nonbinary (42.2%), 82.0% were White, non-Hispanic, 56.9% had a college degree, and 67.0% were financially insecure. The majority reported experiencing childhood abuse (60.6%) and abuse in adulthood (58.0%). The mean frequency of exposure to negative transgender-related media was 6.41 (SD = 2.9) with 97.6% of the sample reporting exposure to negative media depictions of transgender people across a range of mediums. In separate multivariable models adjusted for age, gender identity, race, education, income, and childhood/adult abuse, more frequent exposure to negative depictions of transgender people in the media was significantly associated with clinically significant symptoms of depression (adjusted odds ratio [aOR] = 1.18; 95% confidence interval [CI] = 1.08–1.29; p = 0.0003); anxiety (aOR = 1.26; 95% CI = 1.14–1.40; p

BACKGROUND: Fatal overdoses involving cocaine (powdered or crack) and fentanyl have increased nationally and in Massachusetts. It is unclear how overdose risk and preparedness to respond to an overdose differs by patterns of cocaine and opioid use. METHODS: From 2017 to 2019, we conducted a nine-community mixed-methods study of Massachusetts residents who use drugs. Using survey data from 465 participants with past-month cocaine and/or opioid use, we examined global differences (p < 0.05) in overdose risk and response preparedness by patterns of cocaine and opioid use. Qualitative interviews (n = 172) contextualized survey findings. RESULTS: The majority of the sample (66%) used cocaine and opioids in the past month; 18.9% used opioids alone; 9.2% used cocaine and had no opioid use history; and 6.2% used cocaine and had an opioid use history. Relative to those with a current/past history of opioid use, significantly fewer of those with no opioid use history were aware of fentanyl in the drug supply, carried naloxone, and had received naloxone training. Qualitative interviews documented how people who use cocaine and have no history of opioid use are largely unprepared to recognize and respond to an overdose. CONCLUSIONS: Public health efforts are needed to increase fentanyl awareness and overdose prevention preparedness among people primarily using cocaine.

BACKGROUND: Limited research has explored risk factors for opioid pain medication misuse, concomitant substance misuse, and the unmet behavioral health treatment (BHTx) needs of transgender and gender diverse (TGD) adults. METHODS: In 2019, TGD adults (n=562) in Massachusetts and Rhode Island were purposively recruited and completed a psychosocial and behavioral-health survey (95% online; 5% in-person). Multivariable logistic regression was used to examine factors associated with past 12-month opioid pain medication misuse and unmet BHTx needs. RESULTS: Overall, 24.4% of participants were trans women; 32.0% trans men; and 43.6% were non-binary. Past-year substance misuse included: marijuana (56.8%), hazardous drinking (37.5%), hallucinogens (9.8%), benzodiazepines (8.2%), and opioid pain medication (8.0%). Among participants with past-year substance misuse and BHtx need (n=326), 81.3% received BHtx and 18.7% had unmet BHtx needs. Being a trans woman, having HIV, reported stigma in healthcare, and number of substances misused were associated with increased odds of past-year opioid pain medication misuse; high social connectedness was associated with decreased odds of opioid pain medication misuse (p-values

Key Points Question What is the association of a power outage after a hurricane with hospitalization and mortality among nursing home residents? Findings In this retrospective cohort study of 54 095 nursing home residents in Florida, more than half of residents experienced power loss when Hurricane Irma landed in 2017. Power loss was associated with an increased odds of mortality within 7 days and 30 days after the storm. Meaning The study results suggest that further research should assess the benefits and costs of policies that require nursing homes to have emergency alternate power sources., Importance Exposure to hurricanes is associated with increased mortality and morbidity in nursing home (NH) residents, but the factors contributing to these outcomes are less understood. One hypothesized pathway could be power outages from hurricanes that expose NH residents to excess ambient heat. Objective To determine the association of power loss from Hurricane Irma with hospitalization and mortality in NH residents in Florida. Design, Setting, and Participants This retrospective cohort study of NH residents residing in Florida when Hurricane Irma landed on September 10, 2017, assessed mortality at 7 and 30 days after the storm and hospitalization at 30 days after the storm. The analysis was conducted from May 2, 2021, to June 28, 2021. All NH residents residing in Florida at landfall were eligible (N = 67 273). We excluded those younger than 65 years, missing power status information, or who were evacuated (13 178 [19.6%]). Exposure We used state-administered surveys to determine NH power outage status. Exposed residents experienced a power outage poststorm, whereas unexposed residents did not experience a power outage poststorm. Main Outcomes and Measures We used Medicare claims to assess mortality and hospitalization after Hurricane Irma landfall using generalized linear models with robust standard errors. Results In the aftermath of Hurricane Irma, 27 892 residents (18 510 women [66.4%]; 3906 [14.0%] Black, 1651 [5.9%] Hispanic, and 21 756 [78.0%] White individuals) in 299 NHs were exposed to power loss and 26 203 residents (17 620 women [67.2%]; 4175 [15.9%] Black, 1030 [3.9%] Hispanic, and 20 477 [78.1%] White individuals) in 292 NHs were unexposed. Nursing homes that lost power were similar in size, quality star rating, and type of ownership compared with NHs that did not lose power. Power loss was associated with an increased adjusted odds of mortality among all residents within 7 days (odds ratio [OR],1.25; 95% CI,1.05-1.48) and 30 days (OR, 1.12; 95% CI,1.02-1.23) poststorm and hospitalization within 30 days, although only among residents aged 65 to 74 years (OR, 1.16; 95% CI, 1.03-1.33). Conclusions and Relevance In this cohort study, power loss was associated with higher odds of mortality in all affected NH residents and hospitalization in some residents. The benefits and costs of policies that require NHs to have emergency alternate power sources should be assessed., This cohort study examines the association of power loss from Hurricane Irma with hospitalization and mortality in nursing home residents in Florida.