Sexual and Reproductive Health Education for Youth with Intellectual Disabilities: a Mixed Methods Study of Professionals' Practices and Needs.

We conducted formative research to inform the creation of innovative new tools and strategies to engage professionals in communicating with youth with intellectual disabilities about sexual health. The research was guided by a multidisciplinary network of experts and an advisory board of self-advocates with intellectual disabilities and caregivers that make up Project SHINE: the Sexual Health Innovation Network for Equitable Education. A cross-sectional mixed-methods study utilized survey data from 632 disability support professionals who provide services to youth ages 16-24 with intellectual disabilities (ID). We then conducted focus groups with 36 professionals to obtain more in-depth information related to organizational support needs and suitable contexts, methods, and tools for sexuality education. Participants included licensed/credentialed direct service professionals (social workers, nurses, teachers), non-licensed direct service providers (case managers, supportive care specialists, residential care line staff), and program administrators. Quantitative and qualitative data analyses triangulated the findings across four content areas: attitudes about providing sexual health information to youth with ID, preparedness to communicate about sexuality, current communication practices, and professional needs in the field for new teaching tools and methods. We discuss how findings can be used to guide the creation and successful implementation of innovative new sexual health learning tools for youth with intellectual disabilities.

A PrEP Information and Self-Screening Tool for Women.

Although HIV pre-exposure prophylaxis (PrEP) is effective for women, studies show limited uptake among women to date. Barriers to women's PrEP uptake include their limited knowledge about PrEP and low perceived HIV risk. To address these barriers, we developed and pretested a printed palm card containing HIV prevention/PrEP information that addressed HIV prevention motivation with self-assessment questions about HIV risk. We conducted expert interviews (N = 8), focus groups with health, education, and social service providers (N = 13), and interviews with community women (N = 30) in New York City to assess attention to and acceptability of the card, comprehension of the information, and potential impact on prevention motivation. The card format and content were found to be acceptable and potentially motivational for preventive behaviors, as well as particularly relevant for women. Results of testing for language use, comprehension, and attention guided the final version of the card content.

Raising Awareness of Pre-Exposure Prophylaxis (PrEP) among Women in New York City: Community and Provider Perspectives.

This study explored the knowledge, attitudes, and perceived facilitators and barriers to adoption of HIV pre-exposure prophylaxis (PrEP) among black women and Latinas in the Bronx, NY. Data were collected in focus group discussions (FGDs) held separately with staff (n = 21) and black and Latina female clients aged 18 to 50 (n = 23) of four organizations providing health and social services. Participants were also asked to give feedback about four action messages regarding PrEP for a social marketing campaign. Transcripts were analyzed by two researchers using grounded theory. We found that the majority of clients (74%) and staff (57%) had not heard about PrEP before participating in the FGDs. Following brief educational messaging about PrEP, participants identified potential facilitators and barriers to PrEP uptake among women, and expressed enthusiasm for more widespread efforts to raise awareness about PrEP as an HIV prevention option. Participants preferred an action message that was brief, referred to PrEP as a pill, and did not mention condoms or STD testing. These findings demonstrate the need to raise awareness about PrEP among women and build the capacity of women-serving organizations to educate, screen, and refer or provide PrEP services.

Healing Our Women for Transgender Women: Adaptation, Acceptability, and Pilot Testing.

Healing Our Women (HOW) is a group-level HIV risk-reduction intervention developed to address the role of prior sexual victimization in HIV risk and protective behaviors among HIV-positive women of color. This article describes the process of adapting HOW for transgender women of color in New York City in accordance with CDC guidance for the adaptation of efficacious interventions. Twenty-one transgender women were enrolled in a study to evaluate the acceptability and fidelity of the adapted intervention, and to assess HIV knowledge, depressive symptoms, coping, condom use self-efficacy, and condom use via pre- and post-intervention surveys. We found the adapted program to be feasible to implement and acceptable to participants. We also found significant decreases in depressive symptoms and increases in positive coping from pre- to post-intervention, although replication with a larger sample and a control group comparison is needed to determine efficacy with this population.

Manual compared with electric vacuum aspiration for abortion at less than 6 weeks of gestation: a randomized controlled trial.

OBJECTIVE: To evaluate whether manual or electric vacuum aspiration results in greater immediate confirmation of completed abortion at less than 6 weeks of gestation. METHODS: Five hundred pregnant women presenting for surgical abortion with mean gestational sac diameter of less than 12 mm or no visible sac on ultrasonography were randomized to manual or electric vacuum aspiration. Tissue examination was performed by operating physicians, not blinded to group assignment, and by trained medical assistants, blinded to group assignment. Patients with no products of conception on gross inspection underwent repeat aspiration as necessary and serial human chorionic gonadotropin monitoring. All patients were scheduled for follow-up visits. The primary outcome was detection of products of conception in patients with subsequently confirmed completed abortion. RESULTS: From April 2010 to October 2011, 252 patients were randomized to manual vacuum aspiration and 248 to electric vacuum aspiration. One hundred eighty-two (82%) patients in the manual vacuum aspiration group had products of conception identified and subsequently confirmed completed abortion compared with 164 (76%) patients undergoing electric vacuum patients (P=.13, relative risk 0.83, 95% confidence interval [CI] 0.64-1.07). In pregnancies of sac size 3 mm or less, including no visible sac, five of 29 (17%) patients undergoing manual vacuum aspiration had accurate identification of products of conception compared with four of 31 (13%) patients undergoing electric vacuum aspiration (P=.64, relative risk 0.85, 95% CI 0.44-1.63). Tissue reports of physicians and medical assistants had 90% concordance. Seventy-nine (16%) patients required human chorionic gonadotropin monitoring to confirm completed abortion. There were seven (1.4%) ongoing pregnancies, including four false-positive products of conception results and, among the latter, one presumed ectopic pregnancy. CONCLUSION: Our study supports providing abortions to women who request them before 6 weeks of gestation using either manual or electric vacuum aspiration. Early aspiration is highly effective, although human chorionic gonadotropin monitoring may be necessary to confirm complete abortion. LEVEL OF EVIDENCE: I.

The Adult Roles Models Program: Feasibility, Acceptability, and Initial Outcomes.

We present the feasibility and acceptability of a parent sexuality education program led by peer educators in community settings. We also report the results of an outcome evaluation with 71 parents who were randomized to the intervention or a control group, and surveyed one month prior to and six months after the 4-week intervention. The program was highly feasible and acceptable to participants, and the curriculum was implemented with a high level of fidelity and facilitator quality. Pilot data show promising outcomes for increasing parental knowledge, communication, and monitoring of their adolescent children.

Partner violence and abortion characteristics.

We conducted a retrospective cohort study using randomly selected medical charts of women reporting a history of partner violence and women with no history of partner violence at the time of a family planning or abortion appointment (n = 6,564 per group). We analyzed lifetime history of partner violence for odds of lifetime history of abortion and miscarriage number, and birth control problems. To more closely match timing, we analyzed a subsample of 2,186 women reporting current violence versus not at the time of an abortion appointment for differences in gestational age, medical versus surgical method choice, and return for follow-up visit. After adjusting for years at risk and demographic characteristics, women with a past history of partner violence were not more likely to have ever had one abortion, but they were more likely to have had problems with birth control, repeat abortions, and miscarriages than women with no history of violence. Women with current partner violence were also more likely to be receiving an abortion at a later gestational age. We found no differences between the groups in return for abortion follow-up visit or choice of surgical versus medication abortion. Findings support screening for the influence of partner violence on reproductive health and related safety planning.

An organizational capacity-building program to enhance adolescent sexual and reproductive health.

OBJECTIVES: To present a new practice for promoting sexual health among youth, and a pilot evaluation. The Afterschool Health and Sexuality Education Project is a capacity-building program that provides staff training, technical assistance, resource materials, and policy recommendations to create organizational change that facilitates staff members' abilities to promote sexual and reproductive health for adolescents. METHOD: The evaluation included assessment of (a) sexual health educational materials, resources, and referral lists; (b) organizational policies that guide provision of sexual information and referrals; and (c) communication about sexual health. Data were collected prior to intervention, 7 months later, and 1 year later using anonymous surveys of staff and adolescents, and researcher observations. RESULTS: Results indicate that organizational support for addressing youth sexual health increased as did communication between staff and youth, with decreased barriers. Most, but not all, improvements were maintained at the 1-year follow-up. Organizational policies that support youth sexual health and the availability of educational materials, resources such as condoms, and referral lists also increased and were maintained at follow-up. CONCLUSIONS: Organizational systems change may create a broader, more sustainable environment for increasing communication between youth and adults and increasing resources to promote sexual health.

Factors associated with sexual and reproductive health care by Mexican immigrant women in New York City: a mixed method study.

Limited research has examined barriers to sexual and reproductive health (SRH) services for Mexican immigrant women, especially those living in the eastern United States. This mixed-method study describes SRH care utilization and barriers experienced by female Mexican immigrants living in New York City. One hundred and fifty-one women completed surveys, and twenty-three also participated in focus groups. Usage of SRH care was low apart from prenatal services. The highest barriers included cost, language differences, child care, and poor service quality. After adjusting for insurance status, barriers were associated with receipt of gynecological care from a clinic or private doctor. Greater SRH knowledge was associated with current contraceptive use and a recent PAP test. Women reported that promotoras could increase information about SRH and decrease barriers. Results suggest that in a context where services are geographically available, health care utilization is impacted by lack of knowledge and structural barriers such as language, cost, and child care. Implications for community outreach are discussed.

Safety of digoxin for fetal demise before second-trimester abortion by dilation and evacuation.

BACKGROUND: Digoxin is used to induce fetal demise before dilation and evacuation (D&E) abortion. Published data on the safety of digoxin in abortion care are limited. STUDY DESIGN: We conducted a retrospective cohort study with historical controls at a large family planning center. We reviewed the records of patients at 18 to 24 weeks' gestation who received digoxin before D&E from May 15, 2007 (date the center initiated digoxin use), through March 31, 2008. We also reviewed the records of patients who presented for D&E without digoxin from February 22, 2006, through May 12, 2007. We compared the rates of immediate complications. RESULTS: We included 566 digoxin patients and 513 controls. Eleven spontaneous abortions occurred in the digoxin cohort; none occurred among controls (p<.001). We found 19 cases of infection in the digoxin cohort and three among controls (odds ratio 5.91; 95% confidence interval 1.74-20.07). Eleven digoxin patients were admitted to a hospital after the preoperative visit; no controls were admitted (p<.001). CONCLUSIONS: Patients who received digoxin before D&E were more likely to experience spontaneous abortion, infection and hospital admission than controls who underwent D&E without digoxin.

Barriers to screening for intimate partner violence: a mixed-methods study of providers in family planning clinics.

CONTEXT: Universal screening for intimate partner violence has been recommended for health care settings. However, provider adherence to this recommendation is low, and little research has explored perspectives on relevant policies and procedures among providers in family planning centers. METHODS: In 2009, a sample of 75 health care staff from a large, urban family planning organization that has a protocol for screening for partner violence participated in focus group discussions about their attitudes toward, perceptions of barriers to and preparedness for such screening; 64 of them also completed a brief survey. Multiple analysis of variance was used to assess differences between licensed practitioners (advanced practice clinicians and social workers) and unlicensed health care assistants; findings were analyzed for congruence with and divergence from the focus group data. RESULTS: Barriers included lack of time, training and referral resources, but were reported less by licensed than by unlicensed providers. Overall, participants rated screening as helpful to clients, but licensed providers had more positive attitudes toward and felt more prepared for it than unlicensed ones. In the focus groups, some providers expressed frustration with clients' responses to referrals, concern about taking too much time away from other health care matters and opinions that it was more appropriate for licensed professionals than for unlicensed practitioners to conduct screening. Both licensed and unlicensed staff wanted more training on responding to disclosures of violence. CONCLUSIONS: Family planning providers who are working under an institutional protocol continue to perceive barriers to screening and may benefit from ongoing professional development.

Developing culturally relevant educational materials about emergency contraception.

New York City has growing numbers of Mexican and Caribbean born residents, who have been identified as underserved communities for reproductive health care. We conducted exploratory focus groups to develop and test messages about emergency contraception that would be culturally relevant to these communities. Findings reveal lack of knowledge about what emergency contraception is and how it works, concerns about safety, and health care barriers. Multiple messages were tested in Spanish and English, and participants expressed positive attitudes about using emergency contraception once they knew that is was different from an abortion pill.

Screening for intimate partner violence in reproductive health centers: an evaluation study.

This study compared rates of intimate partner violence reports on a new, empirically-developed screening tool completed by 385 women in 2007 to those from an older tool completed by 420 women in 2006. Data were obtained from randomly selected medical charts across three health center locations, which were part of the same reproductive health care organization. Chi-square analyses were conducted to test associations between demographic characteristics and partner violence reports. Multiple regression analyses were used to compare odds ratios of disclosure by type of screening tool, adjusting for associated demographic factors associated with partner violence reports. Women completing the old and new tools were similar across all demographic characteristics. After adjusting for age and center location, women completing the new screening form were more than 2.5 times as likely to report any partner violence. When analyzed by mutually exclusive violence history categories, women completing the new screening form were over 2.5 times as likely to report past or current violence and over 4 times as likely to report experiencing both past and current violence. Findings suggest that implementing empirically developed brief screening tools for partner violence in reproductive health settings may elicit more disclosures from patients than more traditional tools.

Event-exposure stress, coping, and psychological distress among New York students at six months after 9/11.

This study examines if event-exposure stress has a significant effect on the latent mediating factors of problem-based coping, emotion-based coping, and intrinsic religious motivation, as well as on psychological distress. The study used a single-group correlational design. Data were collected from graduate social work students (N=642) in the New York metropolitan area six months after September 11, 2001. In a structural equation model, event-exposure stress was found to be positively related to problem-focused coping. The model also supported that event-exposure stress had a positive direct effect on psychological distress. While both forms of coping were positively related to levels of distress, higher levels of intrinsic religious motivation were related to lower levels of psychological distress. Professionals should provide guidance to help individuals reduce psychological distress by building upon different coping strategies to best fit the person and the situation.

Social workers' experiences of the world trade center disaster: stressors and their relationship to symptom types.

The study describes New York area social workers' experiences of nine different stressors on 9/11. It also examines their reports of working with clients within the 6 months after 9/11. These variables are then analyzed for their relationship with symptomology 6 months after 9/11. Proximity to the WTC on 9/11, knowing someone who was a primary victim, and talking with clients about events related to 9/11 were all related to symptom levels; however, these experiences differentially impacted levels of depressive, anxiety, and somatic symptoms. Sex and race differences were found among the variables.