An Exploratory Study on Strategies Adopted by Parents Who Use E-Cigarettes to Negotiate Risk Perceptions of Their Children's Secondhand Exposure and Parental Role Modeling.

Existing health messages mainly targeted youth susceptible to vaping or parents who do not have much knowledge about e-cigarettes. This study makes a unique contribution by conducting the first in-depth investigation of e-cigarette-using parents' risk perceptions and parental role modeling and how these two factors affect their vaping behaviors at home or implementation of any strategies to reduce their children's risk. Fifteen parents who used e-cigarettes participated in a semi-structured interview. Interview transcripts were coded and analyzed through a deductive approach of thematic analysis. This study demonstrates the need to develop and disseminate future health messages for e-cigarette-using parents who may have low-risk perceptions of secondhand exposure or who have adopted ineffective strategies to reduce their children's exposure. This study also identifies some possible targets for future intervention efforts through these parents including increasing their knowledge about the health risk of secondhand exposure to e-cigarettes, emphasizing the caregiver role, and effective communications with children about the consequences of vaping.

Transgender-Competent Health Care: Lessons from the Community.

OBJECTIVES: Transgender (trans) individuals experience high discrimination levels when accessing medical and mental health care, resulting in poorer health outcomes compared with the general population and other minority populations. A community-based research design was used to elicit direct input from the trans community about critical trans-knowledgeable care components to address these disparities. The data collection included several focus groups with individuals recruited from the trans community. The information from this research guided the opening of the Gender Center, a centralized, multidisciplinary center of care for trans individuals within an urban safety-net hospital in Atlanta, Georgia. METHODS: The research team conducted five focus groups with 27 self-identified trans individuals between December 2016 and April 2017. Focus groups solicited the negative and positive experiences of trans individuals in the healthcare system and sought input about how best to serve this population. RESULTS: Analysis was done January through April 2020. Focus group participants identified financial difficulties, lack of insurance coverage, being underinsured, discrimination within the healthcare system and from providers, and a shortage of trans-competent providers as the most significant barriers to care. Participants emphasized the need to pay attention to creating a welcoming clinic environment, including trans-positive signage, and integrating trans staff members into the care team. CONCLUSIONS: This study demonstrates the importance of community-based research in addressing health disparities for trans people. It also offers insight into the unmet healthcare needs of the trans community, describes typical healthcare-related experiences of trans individuals, and identifies critical elements for providing high-quality trans-appropriate health care.

Reverse Integration Pilot in a Public Safety-Net Hospital's Outpatient Behavioral Health Clinic.

Individuals with severe mental illness are at a higher risk for medical illness and premature death and yet receive poorer quality healthcare. Often mental healthcare is the only care this population receives, thus models of integration are being explored. This study examined medical outcomes and care utilization patterns among patients at an outpatient behavioral health center where primary care was integrated with psychiatric and behavioral healthcare. A retrospective chart review of patients seen at the clinic both for mental and primary healthcare was performed and 147 patients were monitored over the course of one year. While medical outcome changes were not significant in the year after enrollment, primary care visits did increase, and emergency department visits decreased over the year analyzed. Decreased emergency department visits and increased attendance at primary care visits suggests this model of integration allows patients access to continuity of care and primary care services.

Navigating a Complex Health System: the Perceptions of Psychiatric Residents in Addressing Sexual and Reproductive Health of Women with Severe Mental Illness.

OBJECTIVE: This study's purpose was to examine attitudes and perceptions of resident psychiatrists regarding the sexual and reproductive health needs of their female patients with severe mental illness. The three aims were to investigate resident psychiatrists' (1) perceptions regarding the importance of providing sexual and reproductive health services to female patients in the outpatient behavioral health setting, (2) current engagement in providing sexual and reproductive health services to their female patients, and (3) perceived barriers and facilitators to addressing sexual and reproductive health in this vulnerable patient population. METHODS: Fifteen resident psychiatrists were recruited from the behavioral health clinic at a safety-net public sector hospital for a structured interview. Interviews were recorded, transcribed, and then coded using MAXQDA© software. RESULTS: Resident psychiatrists recognized the importance of addressing sexual and reproductive health with their female patients and recognized their hypothetical ability to provide sexual and reproductive health counseling and services based on their training and resources. However, residents reported rarely providing these services, mostly addressing sexual and reproductive health only when necessitated by medication changes. Perceived barriers included lack of training or knowledge, discomfort, and limited appointment time. CONCLUSIONS: Resident psychiatrists perceive a need to address sexual and reproductive health with their female patients with serious mental illness but lack the confidence and resources to do so. Directed education and clear institutional guidelines are necessary to equip the next generation of psychiatrists with the tools needed to address the sexual and reproductive health needs of women with serious mental illness.