INTRODUCTION: The importance of prenatal care is a well-established principle in the field of obstetric care. Inconsistent, poor and/or inadequate prenatal care is associated with a wide range of poor health outcomes including, pre-term labor, low-birth weight infants and maternal mortality. Hispanic women, specifically migrant/seasonal farmworkers, face a variety of barriers to early and effective prenatal care including: language barriers, poverty, transportation and frequent mobility. Northeast Tennessee has grown to include a robust Hispanic community. Rural Medical Services (RMS), a provider of primary care in rural Tennessee, has developed and implemented a prenatal care outreach program for the local Hispanic population. Through this program Hispanic pregnant women receive educational and clinical services ranging from prenatal education materials and at-home visits to translation services and Lamaze training. The purpose of the current study was to determine the impact of RMS’ prenatal outreach program on the birth outcomes of regional Hispanic mothers. METHODS: A retrospective medical file review using RMS electronic medical records as well as prenatal outreach program documents, including all patients that gave birth during 2013, was conducted. Independent variables included the mother’s age and ethnicity, identification as migrant/seasonal worker, weeks of gestation at first prenatal visit, number of prenatal visits, and number of prenatal outreach visits/contacts. Dependent variables included infant’s gestational age at birth (weeks), infant’s birth weight (oz.), and APGAR scores. RESULTS: In total, 213 women received care for pregnancies with expected due dates in 2013. Of those, birth outcomes data were available for 180. There was no significant difference in the incidence of low birth weight for infants of non-Hispanic and all Hispanic mothers (9.8% v. 4.3%; p=.14) nor was there a significant difference between Hispanic mothers who did not identify as migrant/seasonal farmworkers and those who did (5.1% v. 3.4%; p=.66). Likewise, there was no significant difference in the incidence of pre-term birth (<37 weeks) between non-Hispanic and Hispanic mothers (12.9% v. 8.5%; p=.35) nor was there a significant difference between Hispanic mothers who did not identify as migrant/seasonal farmworkers and those who did (6.7% v. 10.3%; p=.47). While the number of prenatal visits for Hispanic mothers was significantly correlated with birth weight (r=.35; p<.001) and gestational age at birth (r=.40; p<.001), the number of prenatal outreach visits was not significantly correlated with birth weight (r=.16; p=.08) or (r=.15; p=.10). CONCLUSIONS: The RMS prenatal outreach program has closed the prenatal care disparity gap between their Hispanic and non-Hispanic patients. However, there was no therapeutic advantage to an increased number of outreach visits, indicating RMS could standardize the program with a low frequency of visits.

Sexual health affects many aspects of patient health; however, it is often not addressed with patients, and research shows that sexual health is not emphasized in medical education. Primary care providers ought to be on the front lines of the integration of sexual health into patient centered care. In rural areas, this responsibility often falls to family medicine physicians as patients do not have access to Ob/Gyns (obstetrician and gynecologist). The objective of this study was to assess the types and prevalence of sexual health concerns among patients in rural Appalachia and also to assess the comfort level of family medicine physicians in addressing and managing sexual health concerns. Sexual health was defined to include sexual wellness, infections, contraception, and sexual dysfunction. Participants included East Tennessee State University (ETSU) family medicine attending physicians (faculty physicians) and resident physicians at three designated ETSU residency clinic sites. We designed and distributed an eighteen-question survey to residents and faculty physicians in order to evaluate how the recently emerging sexual health emphasis has translated to the practice of family medicine in East Tennessee. Of note in the data analysis, the majority of providers reported they feel at least moderately comfortable discussing sexual health with patients. However, when asked how frequency they address sexual health with patients, most providers reported that they do not frequently ask patients about sexual health concerns. Even though the American College of Obstetrics and Gynecology (ACOG) recommends long-acting reversible contraceptives (LARCs) as first-line contraceptives, less than half of providers recommend LARCs to patients. Additional exploration is needed to address why most family medicine physicians do not ask patients about sexual health as well as to determine if any regional barriers exist. This data also suggests that family medicine providers often do not have the means to recommend first-line contraception, likely due to lack of access and/or lack of knowledge regarding current recommendations. This study suggests that more emphasis should be placed on addressing sexual health and there is a need for additional training perhaps through educational workshops, or the distribution of educational brochures, or training in LARC placement.

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This study explored the contents of stereotypes of women who choose to breastfeed, and how these stereotype attributes differ between men and women. Undergraduate students participated in exchange for modest course credit by completing a series of questionnaires either in-class or via the Internet. All participants completed several questionnaires, including a social behavior inventory, a measure of attitudes toward and embarrassment related to breastfeeding, and a questionnaire designed to assess knowledge of the benefits of breastfeeding. Analysis on 147 participants (60 men and 87 women) utilized Mann-Whitney U tests to compare responses of men and women. Men associated fewer positive and significantly more negative personality traits with women who breastfeed compared to women who do not breastfeed. Women tended to attribute characteristics related to morality (e.g., church-going, conscientious) to women who breastfeed, while men attributed significantly more characteristics related to attractiveness and sexuality (e.g., good physical shape, promiscuous) to women who breastfeed.

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