Qualitative Assessment of Access to Perinatal Mental Health Care: A Social-Ecological Framework of Barriers.

Introduction: Psychological distress affects up to 25% of pregnant women and contributes to poor birth outcomes. Screening with appropriate referral or treatment is critical, yet many women do not access services. This project aimed to identify knowledge of and barriers to mental health services in the perinatal period. Methods: Interviews with low-income pregnant or postpartum women, primary care providers (PCPs), and mental health care providers were conducted in Sedgwick County, Kansas. Interviews were transcribed, independently reviewed using grounded theory, and stratified using a social-ecological model framework. Results: Thirty-three interviews were conducted with 12 (36%) pregnant or postpartum women, 15 (45%) PCPs, and 6 (18%) mental health care providers. Barriers were categorized into three levels: individual, social, and society. Individual level barriers, including cost or lack of insurance and transportation, were consistent across groups, however, women identified barriers only at this level. Provider groups identified barriers at all levels, including lack of support, poor communication between providers, and Medicaid limitations. Conclusions: Multi-level interventions are needed to improve access to mental health care for low-income women in the perinatal period.

A State-Level Examination of School Nurses' Perceptions of Condom Availability Accompanied by Sex Education.

School nurses are often sources of health-care support for teens with sexually transmitted infections (STIs) and unintended pregnancies. However, providing prevention (e.g., condoms) and teaching technical skills (e.g., condom use) needed to reduce high-risk sexual behavior may require a change in perceptions and policies. This study used a cross-sectional study design to assess nurses' perceptions of condom availability accompanied by sex education programs among high school nurses (n = 87) in Kansas. Results showed that school nurses in this study supported condom availability, were comfortable providing condoms, and felt condom availability was within the scope of their job but were less likely to provide condoms because of external barriers. Common barriers include administration, parents, cost, community support, and policies. School nurses, by virtue of their access to the majority of Kansas' adolescents, have the potential to provide sex education and tools such as condoms, so young people can prevent STIs and unintended pregnancies.

Reactive uptake of ozone by chlorophyll at aqueous surfaces.

We report the results of two complementary studies of the heterogeneous reaction between gas-phase ozone and aqueous chlorophyll. In the first experiment, the chlorophyll is present at the air-water interface and its concentration is measured as a function of time, using laser-induced fluorescence, to obtain the surface kinetics. Under most experimental conditions, these are well described using a Langmuir-Hinshelwood formalism. The second experiment was carried out in a wetted-wall flowtube apparatus and measured the uptake coefficient of ozone by the chlorophyll solution. The uptake coefficient decreases with increasing ozone concentration, consistent with the surface mechanism found in the fluorescence experiment. The two experiments agree that the uptake coefficient for ozone by such chlorophyll samples is approximately 2-5 x 10(-6) with unpolluted boundary layer ozone concentrations. At low wind speed, the reaction between ozone and chlorophyll at the sea surface may represent the driving force for ozone deposition at the ocean surface, significantly increasing its deposition velocity there.

Direct experimental evidence for a heterogeneous reaction of ozone with bromide at the air-aqueous interface.

Recent experimental and theoretical evidence has indicated an enhancement of the heavier halide ions at the air-aqueous interface, relative to their bulk concentrations. This, along with an order of magnitude discrepancy between measured and predicted Br2 production in the reaction of ozone with deliquesced NaBr aerosol, has led to the suggestion that an interface reaction occurs between ozone and bromide. We have used harmine, a beta-carboline alkaloid, as an interface-sensitive fluorescent pH probe in order to measure pH changes associated with the interfacial reaction of ozone and bromide. The rate of pH change depends upon the bulk bromide concentration in a way which is well described by a Langmuir-Hinshelwood kinetic model. In the presence of octanol at the interface, the rate of pH change tracks the octanol adsorption isotherm, as expected if octanol enhances the concentration of ozone at the surface.

Photochemical loss of nitric acid on organic films: a possible recycling mechanism for NO(x).

The films coating urban impervious surfaces have been found to be comprised of about 7% inorganic nitrate and approximately 10% organic compounds (by mass). A simple steady-state analysis of the lifetime of the nitrate in the film suggests the existence of a loss process(es) in addition to washout by rainfall. We show here that gas-phase nitric acid can be taken up in organic films and lower the film pH. Photolysis of nitrated films using actinic illumination causes loss both of protons and of nitrate anion. We argue that this is possibly due to a combination of direct and indirect (photosensitized) photochemistry involving nitrate ions, yielding gas-phase HONO and/or NO2.

Suppression of aqueous surface hydrolysis by monolayers of short chain organic amphiphiles.

Aqueous aerosols and other water surfaces in the environment may be coated with organic films, which can give rise to significant effects on gas-solution transport and surface reactivity. We have used acridine as a molecular fluorescent pH probe to examine the hydration of nitric acid and ammonia at both the uncoated and the organic-coated air-water interface. For uncoated samples, a transient decrease in pH is observed at the interface upon introduction of nitric acid vapour, followed by a relaxation to a final pH which is lower than the initial value. This long-time final change in pH is also measured in bulk pH measurements. Solutions having monolayer and sub-monolayer films of 1-octanol do not display the transient, but do show the same long-time change in pH. The degree of suppression of the surface pH transient depends directly on the amount of octanol present at the surface. Hydrolysis of ammonia at the water surface is also indicated by a surface pH transient which is also suppressed when a monolayer of octanol is present at the surface. Monolayers of butanol and of uncompressed stearic acid at the surface show little difference from the clean interface. The results are related to the concentration of available water at the interface.