HPV vaccine promotion: Snapshot of two health departments during the COVID-19 pandemic.

The COVID-19 pandemic has impacted routine health care services including immunization delivery. The most common sexually transmitted infection in the United States is the human papillomavirus (HPV), and its sequelae may be prevented by vaccination. Sequelae that can develop if one's immune system is not able to clear the infection include warts, precancerous lesions, and cancer. The American College of Obstetricians & Gynecologists (ACOG) reports almost everyone who is sexually active will encounter the virus at some time during their life. Most of the estimated 79 million infections occur among people who are in their late teens or early 20s. Since 2006, there has been a vaccine available to prevent HPV infections in both males and females; however, administration of this vaccine has only been about half the rate of other vaccines and vaccine hesitancy may play a role. Public health nurses are vital in providing accurate and nonjudgmental vaccine education to their clients, especially unaccompanied minors seeking care in public health department clinics. This paper will explore the recommendations for providing this vaccine as well as a snapshot of current practice in two health departments in the Southeast region of the United States during the COVID-19 pandemic.

Transgender and gender-expansive youth: Assisting the nurse in providing culturally competent care for our clients and their families.

TOPIC: Society's blue and pink concept of gender has been under a dramatic and controversial shift over the last 10 years. While the general population has been given some latitude in slowly coming to terms with this new understanding, health care providers, specifically nurses, have been under the microscope to demonstrate a perfect blend of competency and compassion when caring for clients who present outside the gender binary. PURPOSE: To clarify the areas of potential impact in the nurse's role and to discuss ways in which they can better equip themselves to promote effective communication and culturally competent care. Thus, we envision heightened empowerment for the nurse to take a more active role in decreasing risks for negative health outcomes such as psychological stress, depression, self-harm, and suicidal ideation in our transgender and gender-expansive youth. SOURCES USED: Utilizing PubMed, nationally recognized websites, and current textbooks/pamphlets, a literature review was conducted to ascertain pertinent information related to transgender, gender-expansive youth, and nursing education. Included references were from 2012 to the present. CONCLUSIONS: Nurses have a unique and dynamic opportunity to provide support and education for our transgender youth and their families, yet often play a minimal role due to inexperience or lack of resources.

Current challenges and opportunities to providing sexually transmitted disease services in STD clinics: A public health leadership perspective.

OBJECTIVE: To assess leaders' perceptions of challenges and opportunities to providing sexually transmitted disease (STD) services in public health departments. DESIGN AND SAMPLE: Semi-structured interviews were conducted in 2017 with health directors and other designated leaders in 19 public health departments who have an STD clinic. Purposive sampling accounted for geographical differences, providing balanced representation of urban, suburban, and rural agencies in North Carolina. MEASUREMENT: Audiotaped interviews were transcribed verbatim. All transcripts were independently coded, with cross comparison and agreement between researchers. Rigorous thematic and content analyses were performed. RESULTS: Perceived stigma, funding constraints, and client-centered issues were identified as the greatest challenges to providing services. Opportunities to improve these services were offering comprehensive screening methods, quality improvement, and public health accreditation. Focused training on revenue and billing practices for staff was acknowledged as the most needed technical assistance. A "culture of free services", perceived by clients and staff, was revealed throughout several themes. CONCLUSIONS: Leaders in publicly funded STD clinics face many challenges and opportunities to providing clinical services. Health directors often serve as change agents and improving the sexual health of communities remains a priority. Results of this study will assist in crafting future policy and practice for STD clinics in the public health sector.

Sexually transmitted disease services and third-party payer reimbursement: Attitudes, knowledge, and current practices among 60 health departments/districts. Why does this matter to public health nurses?

OBJECTIVE: To assess staff attitudes, knowledge, and current practices in billing third-party payers for sexually transmitted disease (STD) services in public health departments/districts. DESIGN AND SAMPLE: A cross-sectional, online survey was administered to staff at 60 urban and rural health departments/districts. Snowball sampling was used for greater representation. There were 311 staff responses from 56 agencies represented in the data analysis. Of the 311 responses, 106 were public health nurses and seven of the health directors had nursing backgrounds. MEASUREMENT: The survey measured attitudes, knowledge, and current billing practices for STD services. Analysis of data was performed at both individual and agency level. RESULTS: Almost 90% reported it was acceptable to bill insurance. However, 56% felt these services should remain a "free" service in the agency. Most agencies were billing Medicaid for STD services (95%) and 70% bill private third-party payers. CONCLUSIONS: Current funding for public STD clinics is not sustainable and other viable income streams such as third-party payer reimbursement must be utilized. Public health nurses play a pivotal role in developing policies and procedures in billing third-party payers for STD and other clinical services. Understanding the interactions between attitudes, knowledge and practice are vital in this development.

Reproductive Coercion: Baby, If You Love Me...

BACKGROUND AND PURPOSE: Reproductive coercion involves behavior that interferes with the individual's unique ability to make decisions about their reproductive health. The concept was first recognized in 2010. Reproductive coercion is intended to maintain power and control in a relationship by someone past, present, or future wishing to be involved in an intimate or dating relationship with an adult or adolescent. Three forms of coercion have been identified: contraceptive sabotage, pregnancy pressure, and control of pregnancy outcomes. METHODS: A search for scientific literature was conducted examining studies involving reproductive coercion as well as evidence-based interventions that could be used by nurses in the clinic setting. CONCLUSIONS: Prevalence of reproductive coercion is estimated to range from 8% to 16%. There is a high association between intimate partner violence (IPV), sexually transmitted infections (STIs), and unintended pregnancy. Adolescents are at greater risk for reproductive coercion than older women. IMPLICATIONS FOR PRACTICE: There are interventions we can incorporate into our clinical practices to screen and assess women for reproductive coercion. Women experiencing reproductive coercion are at risk for unintended pregnancy, STIs, IPV, and forced pregnancy outcomes.

A Survey of 25 North Carolina Health Departments/Districts on Knowledge, Attitudes, and Current Practices to Seeking Reimbursement From Third-Party Payers for Sexually Transmitted Disease Services.

BACKGROUND: North Carolina Administrative Code 10A Chapter 41A.0204 (a) states "local health departments shall provide diagnosis, testing, treatment, follow-up, and preventive services for syphilis, gonorrhea, chlamydia, … These services shall be provided upon request and at no charge to the patient." Although health departments/districts may bill governmental or nongovernmental insurance providers for sexually transmitted disease (STD) services, current billing practices are unknown. Because of its high STD morbidity, the eastern region of North Carolina was targeted. METHODS: Using a Qualtrics Survey developed to measure attitudes as well as knowledge and reimbursement practices, this descriptive study was performed with staff from 25 eastern North Carolina health departments/districts. Snowball sampling was used to allow for greater inclusion. Analysis of data was performed at the individual and agency level based on types of questions in the survey. RESULTS: For knowledge, 87% of the respondents reported being aware of the possibility of reimbursement from third-party payers/commercial insurance carriers for STD services. In regard to current billing of these services, 20 health departments/districts (80%) reported they were billing these payers. When asked about their attitude of seeking reimbursement from commercial insurance, 92% reported it was acceptable or very acceptable. But when asked if STD services should remain a free service at the health department, 55% supported and 45% did not. CONCLUSIONS: These data provide a knowledge base for assisting health departments/districts to move forward in improving STD services as well as maximizing reimbursement from third-party payers/commercial insurance carriers when possible.

Does a satisfactory relationship with her mother influence when a 16-year-old begins to have sex?

PURPOSE: To examine aspects of the mother-daughter relationship as perceived by the 16-year-old (cohesion, flexibility, communication, monitoring, and satisfaction with time spent together) as they relate to when the daughter began having sex. METHODS: A secondary analysis using data from the National Longitudinal Survey of Youth Child (1992-2000) and Young Adult (1996-2004) surveys were analyzed (N = 1,592). Logistic regression models estimated reports of cohesion, flexibility, communication, monitoring, and satisfaction with time spent together with sexual initiation by age 16. All models controlled for the mother's sociodemographic characteristics, lack of independence due to sisters in the sample, and extended time away from mother. RESULTS: Girls who reported being satisfied with the amount of time spent with their mother were less likely to report early sexual initiation. In addition, these girls were three times more likely to report good communication and four times more likely to report high levels of cohesion with their mothers. Individually, in addition to satisfaction with time spent together, high levels of cohesion and good communication were also associated with lower reports of sexual initiation by age 16. CLINICAL IMPLICATIONS: The feeling of being satisfied with the time spent together appears to be a global measure of the individual dimensions of cohesion and communication. Efforts in delaying sexual initiation in adolescents need to be directed at the mother-daughter relationship. Interventions to develop these dimensions within the relationship during early adolescence, as compared to interventions when sexual activity may have already occurred, are warranted.