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Background: Youth identifying as lesbian, gay, bisexual (LGB) and/or transgender/gender nonconforming (TGNC) are at increased risk of violence. School policies and practices may mitigate this risk. Methods: Researchers merged data from the 2016 New Mexico School Health Profiles and the 2017 New Mexico Youth Risk and Resiliency Survey. Researchers employed multivariable logistic regression to test the associations between school-level measures and violence outcomes. Results: Genders and sexualities alliances (GSAs) were associated with reduced odds of lifetime forced sex among all, heterosexual cisgender, and LGB students, reduced odds of sexual violence among heterosexual cisgender students, and reduced odds of dating violence among LGB students. Inclusive sexual health education was associated with reduced odds of lifetime forced sex among LGB and TGNC students, reduced odds of sexual violence among LGB students, and increased odds of dating violence among heterosexual cisgender students. Inclusive teacher training was associated with increased odds of lifetime forced sex among TGNC students. Implications for School Health Policy, Practice, and Equity: Inclusive sexual health education and the presence of active GSAs may have the greatest potential for reducing violence, especially among LGB and TGNC students. Conclusions: Findings highlight the important role of school policies and practices in addressing violence.

Author(s): Jessica R. Fuchs [sup.1] , Melissa A. Schiff [sup.2] , Eirian Coronado [sup.1] Author Affiliations: (1) https://ror.org/00jh2w590, grid.238456.e, 0000 0004 0368 0099, New Mexico Department of Health, , 2040 [...], Background In recent decades, maternal mortality has increased across the U.S. Experiences of pregnant and postpartum people with Substance Use Disorder (SUD)-related deaths have not been previously evaluated in New Mexico. The aim of this study was to analyze risk factors related to substance use and explore substance use patterns among pregnancy-associated deaths in New Mexico from 2015 to 2019. Methods We conducted an analysis of pregnancy-associated deaths to assess the association between demographics, pregnancy factors, circumstances surrounding death, treatment of mental health conditions, and experiences with social stressors among Substance Use Disorder (SUD)-related and non-SUD-related deaths. We performed univariate analyses of risk factors using chi-square tests to assess the differences between SUD-related and non-SUD-related deaths. We also examined substance use at time of death. Results People with SUD-related deaths were more likely to die 43-365 days postpartum (81% vs. 45%, p-value = 0.002), have had a primary cause of death of mental health conditions (47% vs 10%, p < 0.001), have died of an overdose (41% vs. 8%, p-value = 0.002), have had experienced any social stressors (86% vs 30%, p < 0.001) compared to people with non-SUD-related deaths, and received treatment for SUD at any point before, during, or after pregnancy (49% vs. 2%, p < 0.001). The substances most used at time of death were amphetamines (70%), and most cases engaged in polysubstance use (63%). Conclusions for Practice Providers, health departments, and community organizations must prioritize supporting people using substances during and after pregnancy to prevent death and improve quality of life for pregnant and postpartum people.

ObjectiveTo identify factors associated with contraceptive nonuse and use of less effective methods among obese women in the US.Study designWe analyzed data from sexually active obese women (body mass index >30 kg/m²) age 20-44 using the 2006-2010 National Survey of Family Growth. We conducted multinomial logistic regression to assess associations between current contraceptive use and demographic, reproductive and health services factors. Specifically, we compared contraceptive nonusers, behavioral method users (withdrawal and fertility awareness) and barrier method users (condoms) to prescription method users (pill, patch, ring, injection, implant and intrauterine device).ResultsOf 1345 obese respondents, 21.5% used no method, 10.3% behavioral methods, 20.8% barrier methods and 47.4% prescription methods. Only 42.4% of respondents overall and 20.4% of nonprescription method users reported discussing contraception with a provider in the past year. Similar to findings in the general population, behavioral method users were more likely to have previously discontinued a contraceptive method due to dissatisfaction [adjusted RR (aRR), 1.93; 95% confidence interval (CI), 1.09-3.44], and nonusers were more likely to perceive difficulty becoming pregnant (aRR, 3.86; 95% CI, 2.04-7.29), compared to prescription method users. Respondents using nonprescription methods were significantly less likely to have discussed contraception with a healthcare provider (nonusers: aRR, 0.16; 95% CI, 0.10-0.27; behavioral methods: aRR, 0.13; 95% CI, 0.06-0.25, barrier methods: aRR, 0.15; 95% CI, 0.09-0.25) than prescription method users.ConclusionsObese women who discuss contraception with a provider are more likely to use effective contraception and may be less likely to experience unintended pregnancy; however, over half report no recent discussion of contraception with a provider.ImplicationsEfforts are needed to increase contraceptive counseling for obese women, who face increased risks of morbidity from unintended pregnancy.

Context: Identifying how maternal residential location affects late initiation of prenatal care is important for policy planning and allocation of resources for intervention. Purpose: To determine how rural residence and other social and demographic characteristics affect late initiation of prenatal care, and how residence status is associated with self-reported barriers to accessing early prenatal care. Methods: This observational study used data from the 2003 Oregon Pregnancy Risk Assessment Monitoring System (PRAMS) (N = 1,508), with late initiation of prenatal care (after the first trimester) as the primary outcome. We used Rural-Urban Commuting Area (RUCA) codes to categorize maternal residence as urban, large rural, or small/isolated rural. Multivariate logistic regression was used to evaluate whether category of residence was associated with late initiation of prenatal care after adjusting for other maternal factors. Association between categories of barriers to prenatal care and maternal category of residence were determined using the Cochran-Mantel-Haenszel test of association. Findings: We found no significant association between residence category and late initiation of prenatal care, or residence category and barriers to prenatal care initiation. Urban women tended to be over age 34 or nonwhite. Women from large rural areas were more likely to be younger than 18 years, unmarried, and have an unintended pregnancy. Women from small rural areas were more likely to use tobacco during pregnancy. Conclusions: Maternal residence category is not associated with late initiation of prenatal care or with barriers to initiation of prenatal care. Differences in maternal risk profiles by location suggest possible new foci for programs, such as tobacco education in small rural areas.

Objective: The FAC (Focus, Amplify, Compose) rubric for assessing medical students' question formulation skills normally accompanies our Evidence Based Practice (EBP) training. The combined training and assessment rubric have improved student scores significantly. How much does the rubric itself contribute to improved student scores? This study sought to measure student improvement using the rubric either with or without a linked 25-minute training session. Methods: Randomized Controlled Trial. The authors tested the hypothesis that a 25-minute training session combined with use of a rubric would lead to higher scores than a brief explanation of this rubric alone. All 72 participating secondyear medical students had a question formulation rubric briefly explained to them following a pre-test. Students in the intervention groups were taught how to formulate EBP questions for 25 minutes using the rubric followed with another 30 minutes of EBP search training. Students in the control group only received the 30 minutes of EBP search training in their small group labs. All 72 students took the post-test in which they formulated a question in response to a clinical vignette. Statistical analysis to test the hypothesis consisted of a two-sample paired t-test to measure between-group differences. Discussion: Both the intervention and control groups performed significantly better on the post-test for question formulation skills than on the pre-test. When analyzed by extent of individual improvement between pre- and post-tests using a two-sample paired t-test for between group differences, the control group students receiving only a brief explanation of the rubric performed the same statistically (intervention 37.7 versus 37.4 control) as the intervention group students who received the same brief explanation followed by a 25-minute active learning training session. Thus, the results provided no support of the hypothesis that the extra 25-minute training improved post-test scores. The rubric itself contributed similarly to the intervention groups students' improvement as the combined rubric and training for control group students. This finding could potentially save scarce curricular time. Key Messages: The FAC question formulation rubric and training significantly improves medical students' EBP question quality. The FAC rubric coupled with only a 5-minute explanation can be effective. In a crowded medical school curriculum, the rubric and brief explanation might save valued time for other purposes. [ABSTRACT FROM AUTHOR]

Evaluate the association between current recommendations for active labor duration in nulliparous women undergoing labor induction and adverse perinatal outcomes. Retrospective cohort study from 2012 to 2015. Subjects were nulliparous, 18–44 years, cephalic, singleton ≥37 weeks undergoing labor induction who reached active labor. We created three subgroups, defined by active labor duration from 6 to 10cm as < the median, median-95th percentile, and >95th percentile based on contemporary labor curves. We evaluated the association between subgroups and cesarean delivery, chorioamnionitis, blood loss (EBL), 5-minute Apgar score < 7, and neonatal intensive care unit (NICU) admission using logistic regression. Among 356 women, 34.8% had an active labor duration < median, 43.3% were between the median-95th percentile, and 21.9% were >95th percentile. The risk of cesarean delivery increased with longer active labor duration; 1.8-fold (95%CI = 1.1–3.1) and 4.0-fold (95%CI = 2.5–6.5) for women whose active labors were between the median-95th percentile and >95th percentile, respectively. Chorioamnionitis increased by 3.9-fold (95%CI = 1.2–13.2) in the >95th percentile subgroup. Active labor length was not associated with EBL, Apgar scores, or NICU admission. Cesarean delivery and chorioamnionitis increased significantly as induced active labor duration exceeded the median. This study provides a better understanding regarding the risks of longer active labor as defined by contemporary labor curves. [ABSTRACT FROM AUTHOR]