Mail-Order Pharmacy Dispensing of Mifepristone for Medication Abortion After In-Person Screening.

Importance: Before 2021, the US Food and Drug Administration required mifepristone to be dispensed in person, limiting access to medication abortion. Objective: To estimate the effectiveness, acceptability, and feasibility of dispensing mifepristone for medication abortion using a mail-order pharmacy. Design, Setting, and Participants: This prospective cohort study was conducted from January 2020 to May 2022 and included 11 clinics in 7 states (5 abortion clinics and 6 primary care sites, 4 of which were new to abortion provision). Eligible participants were seeking medication abortion at 63 or fewer days' gestation, spoke English or Spanish, were age 15 years or older, and were willing to take misoprostol buccally. After assessing eligibility for medication abortion through an in-person screening, mifepristone and misoprostol were prescribed using a mail-order pharmacy. Patients had standard follow-up care with the clinic. Clinical information was collected from medical records. Consenting participants completed online surveys about their experiences 3 and 14 days after enrolling. A total of 540 participants were enrolled; 10 withdrew or did not take medication. Data were analyzed from August 2022 to December 2023. Intervention: Mifepristone, 200 mg, and misoprostol, 800 µg, prescribed to a mail-order pharmacy and mailed to participants instead of dispensed in person. Main Outcomes and Measures: Proportion of patients with a complete abortion with medications only, reporting satisfaction with the medication abortion, and reporting timely delivery of medications. Results: Clinical outcome information was obtained and analyzed for 510 abortions (96.2%) among 506 participants (median [IQR] age, 27 [23-31] years; 506 [100%] female; 194 [38.3%] Black, 88 [17.4%] Hispanic, 141 [27.9%] White, and 45 [8.9%] multiracial/other individuals). Of these, 436 participants (85.5%; 95% CI, 82.2%-88.4%) received medications within 3 days. Complete abortion occurred after medication use in 499 cases (97.8%; 95% CI, 96.2%-98.9%). There were 24 adverse events (4.7%) for which care was sought for medication abortion symptoms; 3 patients (0.6%; 95% CI, 0.1%-1.7%) experienced serious adverse events requiring hospitalization (1 with blood transfusion); however, no adverse events were associated with mail-order dispensing. Of 477 participants, 431 (90.4%; 95% CI, 87.3%-92.9%) indicated that they would use mail-order dispensing again for abortion care, and 435 participants (91.2%; 95% CI, 88.3%-93.6%) reported satisfaction with the medication abortion. Findings were similar to those of other published studies of medication abortion with in-person dispensing. Conclusions and Relevance: The findings of this cohort study indicate that mail-order pharmacy dispensing of mifepristone for medication abortion was effective, acceptable to patients, and feasible, with a low prevalence of serious adverse events. This care model should be expanded to improve access to medication abortion services.

Addressing the Shortage of Academic Nurse Educators: Recommendations for Educational Institutions Based on Nominal Group Technique Research.

AIM: The purpose of this qualitative study was twofold: 1) explore factors contributing to the shortage of academic nurse educators (ANEs) and 2) identify opportunities to address these factors from the perspectives of nursing education institutions. BACKGROUND: The nurse faculty shortage is a major national concern, with inadequate recruitment and retention. Addressing the nursing faculty shortage is important to maintain a sustained nursing workforce. METHOD: Using a nominal group technique (NGT), a group of 45 diverse nurse educators from across the United States formed a virtual workgroup. RESULTS: Findings led to an action plan formulated to guide educational institutions with ways to decrease the ANE shortage through recruitment and retention. CONCLUSION: The evidence demonstrates the need for educational institutions to concentrate efforts on recruiting and retaining ANEs to combat the nursing shortage. The analysis offers recommendations to institutions to increase the number of qualified ANEs.

Person- and Incident-Level Predictors of Blame, Disclosure, and Reporting to Authorities in Rape Scenarios.

Rapes perpetrated during college are both common and underreported. Research highlights that several person- and incident-level factors relating to gender and sexuality may diminish reporting, by themselves and as they pertain to attributions of blame for the assault. In this study, male and female college students (N = 916) read vignettes describing a rape perpetrated by a man against a woman, a man against a man, or a woman against a man. Participants rated the blameworthiness of both perpetrator and victim and rated the likelihood that they would disclose the rape to social ties or health services or report it to authorities if they were in the victim's position. We found that male gender and heterosexual orientation predicted higher victim blame, lower perpetrator blame, and lower likelihood of disclosure, although relative endorsement of masculine gender ideology seemed to be driving these associations, as well as predicted lower likelihood of reporting to authorities. Controlling for other factors, vignettes portraying a woman raping a man led to a lower likelihood of disclosing or reporting the assault, compared with a male-on-female rape. We also found that the effects of female-on-male rape and traditional masculine ideologies tied to rape disclosure partially by decreasing blame to the perpetrator, which itself carried a unique influence on decisions to report. Our findings overall indicate that factors related to gender, sexuality, and blame have myriad influences and may contribute to low rates of disclosing rape to important outlets.

Randomized Trials of the Teen Outreach Program in Louisiana and Rochester, New York.

OBJECTIVES: To evaluate the Teen Outreach Program, a pregnancy prevention program, in 2 community-based settings. METHODS: We evaluated the Teen Outreach Program, a 9-month positive youth development program, in 3 cohorts of youths from 2012 to 2015 in 2 states. In Louisiana, 7 agencies participated in an individualized randomized controlled trial, with youths randomly assigned to a treatment or control condition. Fourteen agencies in Rochester, New York, participated in a cluster randomized controlled trial. RESULTS: We found no differences between the intervention and control youths on delay of sexual onset in Louisiana (adjusted odds ratio [AOR] = 0.80; 95% confidence interval [CI] = 0.62, 1.03) or in Rochester, New York (AOR = 0.89; 95% CI = 0.45, 1.77), or for sex with no effective means of birth control (Louisiana, AOR = 1.18; 95% CI = 0.78, 1.78; Rochester, AOR = 0.41; 95% CI = 0.13, 1.27) after controlling for relevant covariates. CONCLUSIONS: We found no short-term effects for the offer of the intervention. Research might be needed for the long-term and intermediate impacts of youth development programs on these and other adolescent risk behaviors.

The potential for cross-addiction in post-bariatric surgery patients: Considerations for primary care nurse practitioners.

BACKGROUND AND PURPOSE: Possible mental health issues for post-bariatric surgery patients include the development of cross-addictions after the rapid weight loss period. No validated screening tool to assess for possible cross-addictions exists. The main purpose of this study was to develop recommendations for modifying an existing addiction screening tool (the Shorter PROMIS Questionnaire) for use by primary care providers. METHODS: A qualitative descriptive design was used with triangulation of input from the scholarly literature, content experts (CEs), and post-bariatric surgery patients. Three focus groups were conducted with post-bariatric surgery patients (n = 12) with the same questions asked of the CEs (n = 3). Content analysis was used to analyze the transcripts. CONCLUSIONS: The following themes regarding addictions after bariatric surgery were identified through consensus: alcohol, gambling, shopping, exercise, food starving/bingeing, and sexuality/relationships. Dissonant themes included caffeine and tobacco by the post-bariatric surgery patients and prescription/illicit medications by the CEs. IMPLICATIONS FOR PRACTICE: Targeted screening for early identification of problem behaviors by primary care providers may result in appropriate referral to and management by mental health providers, assisting ongoing success of bariatric surgery.

Promoting heart health in rural women.

PURPOSE: To compare 2 strategies, stage-matched nursing and community intervention (SMN+CI) and community intervention (CI) alone in changing cardiovascular risk factors in up to 3 behavioral areas: diet, physical activity, and/or smoking among rural women. METHODS: A 14-month, multisite randomized controlled trial of 117 rural women was conducted. Transtheoretical model was used in identification of stage of change and development of the SMN+CI nursing interventions. A social-ecological model was used to address issues of rurality in the development of interventions. FINDINGS: The SMN + CI group was superior on 4 outcomes. There were significant increases in 2 measures of dietary intake; improvement in dietary stage of change for fruits and vegetables; and reduced diastolic blood pressure (DBP) in the SMN + CI group. After log transformation DBP significance was lost. The CI group had a significant reduction in change in total cholesterol; however, significance was lost after control for the initiation of lipid lowering medications. There was a significant reduction in Framingham risk scores pre- to postintervention, regardless of group. CONCLUSIONS: There continues to be a need to improve cardiovascular risk factors in rural women. There should be an exploration of whether intensified dose and fidelity of the intervention strategies of diet and physical activity are effective in improving anthropometric and laboratory values. Further investigation is warranted into factors influencing the pre- to postreduction in Framingham risk scores.

Avoiding early study attrition in adolescent girls: impact of recruitment contextual factors.

This descriptive study examined factors associated with adolescent girls continuing in a randomized controlled trial of an HIV-prevention intervention after enrollment based on an analysis of locator form and demographic data. When the authors piloted the study, 48% (62 of 129) of the participants (aged 15-19 years) continued in the intervention after enrollment. Once a formal recruitment and retention protocol was initiated, 80% (264 of 334 girls 15-19 years old) returned after enrollment. Chi-square analyses found statistically significant differences (p < .001 to .05) between the girls who continued (n = 264) and those who did not (n = 68), associated with recruiter's experience, recruitment method, contact status, and parental awareness of study participation. Living situation was not relevant, nor was being able to receive email or cell phone messages. These findings suggest factors to consider when developing and implementing recruitment protocols to enhance retention in clinical trials involving adolescent girls.

Preliminary efficacy of a comprehensive HIV prevention intervention for abstinent adolescent girls: pilot study findings.

We developed and pilot-tested a comprehensive HIV prevention/sexual risk reduction intervention with 54 sexually abstinent girls and estimated the effect of the intervention on three antecedents of sexual risk behavior: information, motivation, and behavioral skills. Girls ages 14-18 were randomized into either (a) an AbsPlus intervention or (b) a structurally equivalent control group. Assessments were obtained at baseline and 3 months follow-up using audio computer assisted self-interview. The intervention resulted in a large effect for information (d = 1.11); small to large effects for the motivational measures (d = .34-.88), and a moderate effect for a measure of behavioral skills (d = .67). The results indicate that antecedents of sexual risk behavior change were improved by a gender-specific theoretically guided intervention.

Understanding sexual abstinence in urban adolescent girls.

OBJECTIVES: To gain insight into the context of sexual abstinence and identify potential determinants of abstinence in this population. DESIGN: Four focus groups. PARTICIPANTS AND SETTING: Twenty-four, predominantly African American (88%) girls aged 14 to 19 years were recruited from urban health centers and youth development programs in Rochester, New York, between September and December 2006. DATA ANALYSIS: Content analysis was used to analyze the four verbatim transcripts. Using analytic induction, groups were compared and contrasted at the micro (within-group) and macro (between-group) levels to identify themes. RESULTS: Four themes were identified that provided insight into how and why these girls remain abstinent despite being in sexually active social climates. They focused on the following: self-respect (I'm worth it), impact of mothers (Mama says ... think before you let it go), influence of boys and other peers (Boys will be boys), and potential negative consequences of sex (Hold on, there's a catch). CONCLUSIONS: Developing interventions to maintain abstinence, delay onset of sexual activity, and promote protected first and subsequent sexual contact in abstinent girls are key to decreasing future sexual risk. These findings suggest opportunities to develop HIV prevention strategies tailored to the needs of abstinent girls.