Academic Health Center-Community Justice Program Partnerships: Linking Men in the Justice System to Health Care.

BACKGROUND: Linkage to community health and social services after incarceration is often inadequate. This is troubling, because risk taking and poor health are common immediately after release, and access to health providers and insurance helps individuals to transition home. OBJECTIVES: This article describes how faculty and clinicians at a large academic health center in New York City, established partnerships with justice programs to jointly develop services that aimed to increase health care access for men in the justice system. METHODS: We describe how faculty and students from Columbia University's Mailman School of Public Health (MSPH), clinicians from New York-Presbyterian Hospital's (NYPH) Young Men's Clinic (YMC) and project STAY, and staff from justice programs collaborated to increase access to care. RESULTS: We highlight the characteristics of successful partnerships drawn from the literature on community-based participatory research. CONCLUSION: We conclude with a discussion of some challenges we encountered and lessons we learned about establishing and sustaining partnerships with court, probation, parole, reentry, and diversion programs while educating the next generation of public health leaders.

Real men do...real men don't: Young Latino and African American men's discourses regarding sexual health care utilization.

There is growing recognition that men as well as women need sexual health care (SHC) services. Despite this, male friendly sexual health services are not readily available in the United States, and men are underutilizing the services that are available. This situation needs to be rectified to improve sexual health outcomes for men and women. In this study we conducted 10 focus groups with young adult Latino and African American men to examine their perceptions of the factors influencing SHC utilization among the men they know, with an emphasis on how notions of what it means to be a man affects health care seeking. The findings both amplify and complicate the relationship between masculinity and SHC seeking. They suggest new directions for public health efforts to enhance men's SHC utilization.

Creating teachable moments: a clinic-based intervention to improve young men's sexual health.

A multicomponent health education intervention for men was integrated into initial visits at the Young Men's Clinic in New York City. In all, 157 predominantly low-income, Latino and African American patients completed pre- and post-test surveys to assess their sexual and reproductive health knowledge, beliefs, attitudes, and behaviors. Paired t tests compared respondents' scores on outcome variables at baseline and follow-up. Intervention participants significantly increased their knowledge (e.g., emergency contraception) and frequency of safer sexual behaviors (e.g., condom use) during the 3 months following their initial visit. The intervention was not as successful promoting positive beliefs about health care utilization or attitudes about condoms. Participants reported high levels of satisfaction with the intervention. This study provides evidence that it is feasible to effectively disseminate sexual health information to men at each step of a routine clinic visit, including down time in waiting rooms and individual encounters with health educators and medical providers.

Prior pill experiences and current continuation among pill restarters.

CONTEXT: Discontinuation of oral contraceptives often puts women at risk for unintended pregnancies. Understanding why a woman discontinued pill use can provide insight into her risk of discontinuation if she restarts use. METHODS: Women younger than 25 obtaining oral contraceptives at three university health centers in 2003-2005 were recruited to participate in a randomized trial; 628 former users were interviewed about their previous experience with the method, and were followed up three months after restarting use. Bivariate and multinomial logistic regression analyses were used to assess the relationship between prior reasons for stopping pill use and method continuation. RESULTS: Women who had discontinued using oral contraceptives because of side effects were less likely to be very sure about restarting the pill at baseline (73%) than were those who had stopped for logistical or fertility-related reasons (88-94%). They also were less likely to have been satisfied with the pill in the last use interval (49% vs. 95-98%) and less likely to be satisfied with it in the three months after restarting (76% vs. 89-93%). These women were more likely to report a short duration of use than an intermediate duration or continuous use during follow-up (odds ratios, 2.5 and 4.5). CONCLUSIONS: When counseling women who are restarting pill use, providers should ask about their experiences with the method and reasons for discontinuation; counseling for women who discontinued because of side effects should address their risk factors for early discontinuation and informing them about other contraceptive choices.

Medical pluralism among American women: results of a national survey.

BACKGROUND: Medical pluralism can be defined as the employment of more than one medical system or the use of both conventional and complementary and alternative medicine (CAM) for health and illness. American women use a variety of health services and practices for women's health conditions, yet no national study has specifically characterized women's medical pluralism. Our objective was to describe medical pluralism among American women. METHODS: A nationally representative telephone survey of 808 women >or=18 years of age was conducted in 2001. Cross-sectional observations of the use of 11 CAM domains and the use of an additional domain--spirituality, religion, or prayer for health--during the past year are reported. Women's health conditions, treatments used, reasons for use, and disclosure to conventional physicians are described, along with predictors of CAM use. RESULTS: Over half (53%) of respondents used CAM for health conditions, especially for those involving chronic pain. The majority of women disclosed such practices at clinical encounters with conventional providers. Biologically based CAM therapies, such as nutritional supplements and herbs, were commonly used with prescription and over-the-counter (OTC) pharmaceuticals for health conditions. CONCLUSIONS: Medical pluralism is common among women and should be accepted as a cultural norm. Although disclosure rates of CAM use to conventional providers were higher than in previous population-based studies, disclosure should be increased, especially for women who are pregnant and those with heart disease and cancer. The health risks and benefits of polypharmacy should be addressed at multiple levels of the public health system.

Patterns of men's use of sexual and reproductive health services.

CONTEXT: Men have been neglected as a target population for sexual and reproductive health services. As a result, little is known about the rates and antecedents of men's service utilization. METHODS: Data from the 2002 National Survey of Family Growth were used to examine utilization of sexual and reproductive health services among 3,611 men aged 20-44 who had ever had sex with a woman. Associations between demographic and behavioral variables and measures of service utilization were assessed in univariate and logistic regression analyses. RESULTS: Only 48% of men reported receiving sexual and reproductive health services in the past year. The testicular exam was the most commonly received service (35%), but half of men who had had a testicular exam had received no other sexual and reproductive health services. Levels of unmet need for services among men engaging in sexual risk behaviors were substantial (32-63%). The odds of having received nontesticular services were elevated among men who were nonwhite and older, engaged in sexual risk behaviors, had had a physical exam and had public health insurance. The odds of having received only a testicular exam were elevated among men who were white, had lower levels of sexual risk, had had a physical exam and had private or no insurance. CONCLUSIONS: Men who have sex with women are not receiving adequate levels of sexual and reproductive health care, and the care they receive is neither comprehensive nor integrated. Standards of clinical care need to be defined and communicated to men and providers.

Initiation of oral contraceptives using a quick start compared with a conventional start: a randomized controlled trial.

OBJECTIVE: To estimate whether young women taking the first pill on the day of prescription had higher continuation rates and lower pregnancy rates than women who waited until menses to start the oral contraceptive pill (OCP). METHODS: We recruited 1,716 women aged younger than 25 years seeking to initiate the oral contraceptive at three publicly funded family planning clinics, and randomly assigned them to conventional initiation of the pill (conventional start) or immediate, directly observed ingestion of the first pill (quick start) during the clinic visit. Women underwent follow-up interviews at 3 and 6 months. RESULTS: Sixty percent of participants discontinued the pill, and 8% became pregnant during follow-up. Women who took the first pill in the clinic were more likely to continue to the second OCP pack (odds ratio 1.5, 95% confidence interval 1.0-2.1.); however, the Quick Start approach did not improve OCP continuation rates at 3 and 6 months. Those assigned to Quick Start were slightly less likely to become pregnant within 6 months from the time they started the pill (hazard ratio 0.90, 95% confidence interval 0.64-1.25). Eighty-one percent of women rated the Quick Start approach as acceptable or preferable to waiting. Rates of serious adverse events were low and similar in the two groups. CONCLUSION: Protocols that require a woman to wait until the next menses to start hormonal contraceptives are an obstacle to contraceptive initiation. Directly observed, immediate initiation of the pill improves short-term continuation. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00068848

Oral contraceptive discontinuation: do side effects matter?

OBJECTIVE: The purpose of this study was to assess self-reported side effects in women after they received the oral contraceptive (OC) and to compare discontinuation rates, according to presence or absence of side effects. STUDY DESIGN: The study comprised 1716 women aged <25 years who initiated the OC at 3 publicly funded family planning clinics and completed structured interviews after 3 and 6 months. RESULTS: Nearly 60% of subjects discontinued the OC by 6 months. Most subjects reported no changes in headaches, weight, moodiness, and sexual satisfaction during the first 3 months of OC use. Subjects with any complaints, especially women with increased headaches or moodiness, were more likely to discontinue the OC prematurely. Nonetheless, most discontinuation occurred for reasons that were unrelated to side effects. CONCLUSION: Side effects are absent or mild among most OC users, but women with complaints are more likely to discontinue. Side effects are less important reasons for discontinuation than widely believed.

Women's reasons for complementary and alternative medicine use: racial/ethnic differences.

OBJECTIVES: Although racial/ethnic differences in the prevalence of complementary and alternative medicine (CAM) utilization have been documented, differences in the reasons for using CAM have not been empirically assessed. In an increasingly diverse society, understanding differences in rates of and reasons for CAM use could elucidate cultural and social factors of health behaviors and inform health care improvements. The current study examines reasons for CAM use among women in four racial/ethnic groups. DESIGN: A national telephone survey of 3172 women aged 18 years and older was conducted in four languages. Respondents were asked about their use of remedies or treatments not typically prescribed by a medical doctor. This study focuses on those women who used CAM in the previous year and their reasons for using CAM. RESULTS: Non-Hispanic white women were most likely to cite personal beliefs for CAM use. Cost of conventional medicine was most prevalent among Mexican-American women CAM users. Physician referral, family and friends, and media sources were all equally likely to lead to CAM use in non-Hispanic white women. In contrast, informal networks of family and friends were the most important social influences of CAM use among African-, Mexican-, and Chinese-American women. CONCLUSIONS: Racial/ethnic differences in reasons for CAM use highlight cultural and social factors that are important to consider in public evaluation of the risks and benefits of CAM remedies and treatments.

Race/ethnicity and women's use of complementary and alternative medicine in the United States: results of a national survey.

OBJECTIVES: We studied the use of complementary and alternative medicine (CAM) among women in 4 racial/ethnic groups: non-Hispanic Whites, African Americans, Mexican Americans, and Chinese Americans. METHODS: We obtained a nationally representative sample of women aged 18 years and older living in the United States in 2001. Oversampling obtained 800 interviews in each group, resulting in a sample of 3068 women. RESULTS: Between one third and one half of the members of all groups reported using at least 1 CAM modality in the year preceding the survey. In bivariate analyses, overall CAM use among Whites surpassed that of other groups; however, when CAM use was adjusted for socioeconomic factors, use by Whites and Mexican Americans were equivalent. Despite the socioeconomic disadvantage of African American women, socioeconomic factors did not account for differences in CAM use between Whites and African Americans. CONCLUSIONS: CAM use among racial/ethnic groups is complex and nuanced. Patterns of CAM use domains differ among groups, and multivariate models of CAM use indicate that ethnicity plays an independent role in the use of CAM modalities, the use of CAM practitioners, and the health problems for which CAM is used.

Religion, spirituality, and healthcare choices of African-American women: results of a national survey.

OBJECTIVE: This study describes the prevalence and patterns of use of religion and spirituality for health reasons among African-American women. METHODS: Respondents were asked about their use of religion/spirituality for health reasons as part of a larger study of the prevalence and correlates of complementary and alternative medicine (CAM) use among women. In 2001, a national survey of 3,172 women, aged 18 and older, was conducted in 4 languages, with over-sampling among African-, Mexican-, and Chinese-American participants. This paper focuses on the sub-sample of 812 African-American women. RESULTS: Overall, 43% of the African-American women reported using religion/spirituality for health reasons in the past year. Factors significantly associated with the use of religion/spirituality for health reasons included having an income of dollar 40,000-dollar 60,000, an education level of college graduate or more, or being 37-56 years of age; worse health status approached significance. African-American women utilized religion and spirituality most often for serious conditions such as cancer, heart disease, and depression. African-American women who had used religion/spirituality in the past year for health reasons were more than twice as likely to have used some form of CAM, and also more likely to have seen a medical doctor during the year prior to the interview, compared to their counterparts. CONCLUSION: Religion and spirituality are associated with health-seeking behaviors of African-American women. The use of religion and spirituality for health reasons warrants additional research, particularly its use for chronic and serious conditions, and its role in the health-seeking behavior of African-American women in conjunction with the utilization of conventional medicine and CAM.

Nonvolitional sex and sexual health.

Nonvolitional sex is sexual behavior that violates a person's right to choose when and with whom to have sex and what sexual behaviors to engage in. The more extreme forms of this behavior include rape, forced sex, childhood sexual abuse, sex trafficking, and violence against people with nonconventional sexual identities. More nuanced forms of nonvolitional sex include engaging in sexual behavior that masks one's nonconventional sexual identity, or that protects one's position with peers, or that represents a quid pro quo for the economic support that one obtains within an intimate relationship. The aim of this essay is to highlight the ways in which nonvolitional sex threatens sexual health and to identify strategies for ameliorating this problem. These strategies will have to be as broad in scope as is the problem that they are designed to address. The essay discusses the following strategies to reduce nonvolitional sex: (1) advocacy for sexual rights, gender equality, and equality for individuals with nonconventional sexual identities; (2) primary prevention programs and interventions that offer comprehensive sexuality education that establishes volitional sex and sexual health as basic human rights; (3) health services that routinely ask clients about their experiences with nonvolitional sex in an open and culturally appropriate manner; and (4) secondary prevention programs to meet the needs of victims of nonvolitional sex identified by the "screening" programs.