strong>Objectives: Women with substance use disorders experience unique challenges to contraceptive obtainment and user-dependent method adherence, contributing to higher than average rates of unintended pregnancy. This study estimated the prevalence of barriers to contraception and their associations with contraceptive use and unwanted pregnancies among women receiving opioid agonist therapy (OAT) in northeast Tennessee. Methods: A cross-sectional survey was piloted among female patients aged 18 to 55 years from 2 OAT clinics. Logistic regression was used to evaluate associations between contraceptive barriers and current contraceptive use and previous unwanted pregnancies among women receiving OAT. Results: Of 91 participants, most experienced previous pregnancies (97.8%), with more than half reporting unwanted pregnancies (52.8%). Although 60% expressed a strong desire to avoid pregnancy, ambivalence toward becoming pregnant was common (30.0%). Most experienced ≥1 barriers to contraceptive use or obtainment (75.8%), the most prevalent being aversion to adverse effects (53.8%), healthcare provider stigmatization (30.7%), scheduled appointment compliance (30.3%), and prohibitive cost (25.0%). Experience of any contraceptive barrier (adjusted odds ratio [AOR] 8.64, 95% confidence interval [CI] 2.03–36.79) and access to a contraceptive provider (AOR 5.01, 95% CI 1.34–18.77) were positively associated with current use of prescribed contraceptives, whereas prohibitive cost was negatively associated (AOR 0.28, 95% CI 0.08–0.94). Conclusions: Although most participants desired to avoid pregnancy, ambivalence or uncertainty of pregnancy intention was common. Most experienced barriers to contraception, which were more strongly associated with previous unwanted pregnancy than current contraceptive use. The provision of long-acting reversible contraceptives and contraceptive education at OAT clinics represents an opportunity to reduce the incidence of neonatal abstinence syndrome.

Introduction. Research on teen childbearing has consistently noted that unfavorable socioeconomic conditions experienced at the community and family levels underpin disparities in teen birth rates. However, rather than examining socioeconomic factors alone, community-level differences in teen births could be measured by examining in tandem, the intersection between sociodemographic deprivation and health professional shortage areas (HPSA). Objectives. To examine the differences in teen birth rates by sociodemographic deprivation and HPSA in rural and urban counties of the United States. Methods. Results. Of the 3,136 counties, 78.7% of rural counties were in the highest category of socio-demographic deprivation compared to about 21.1% of urban counties. 76.0% of rural counties were categorized as having shortages of primary care, dental, and mental health providers, compared to 24.0% of urban counties. Rural counties had an additional 7.4 births per 1,000 females aged 15-19 years (p <0.0001) when compared to urban counties. The highest level of sociodemographic deprivation had a strong positive association with teen birth rates (β = 17.46; SE = 0.53; p < 0.0001). Rural counties with the whole designation of a health professional shortage increased county-level teen births by 7.18 births per 1,000 females aged 15-19 years (p <0.0001), compared to urban counties with no designation. Rural counties with higher levels of sociodemographic deprivation and a designation of health professional shortages in at least one area had significantly higher teen births than their urban counterparts (p <0.0001). Conclusions. Rural communities across different levels of deprivation and HPSA designated categories continue to have disproportionately greater teen birth rates. While these findings reveal the unique characteristics of sociodemographic and HPSA as a useful social determinant of teen birth, rural communities showed inherent vulnerabilities that contribute to poorer teen birth outcomes. Future research should examine the extent to which access to contraceptive services differs among rural and urban communities and the role of rural safety net providers in the provision of these services.

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backgroundWomen with opioid use disorder (OUD) experience unique barriers to contraception, contributing to higher than average rates of unintended pregnancy. Rates of neonatal abstinence syndrome (NAS), a drug withdrawal syndrome resulting from antenatal drug exposure, are higher in Tennessee than the nation. Few studies have quantified experience of contraceptive barriers or their associations with contraceptive use among women with OUD. objectives This study estimated prevalence of barriers to access/acceptance of contraceptive services and their associations with current contraceptive use and unwanted pregnancy among reproductive-aged women in Northeast Tennessee receiving opioid agonist therapy (OAT). methods A cross-sectional survey was administered to female patients aged 18-55 from two OAT clinics. Logistic regression was used to evaluate associations between contraceptive barriers and current contraceptive use and previous unwanted pregnancies. results Of 91 participants, most were insured (84.4%), experienced at least one barrier (75.8%), and more than half reported unwanted pregnancies (52.8%). Most desired to avoid pregnancy (60.0%) or were ambivalent (30.0%). Common barriers were side effect aversion (53.8%), provider stigmatization (30.7%), appointment compliance (30.23%), and cost (25.0%). Experience of any barrier (AOR=11.6, 2.25-59.8) and access to a contraceptive provider (AOR=9.78, 1.34-71.7) were positively associated with use, while cost was negatively associated (AOR=0.27, 0.07-0.98). Eight barriers were significantly associated with unwanted pregnancies. conclusionWhile most participants desired to avoid pregnancy, contraceptive barriers were common. Barriers were more strongly associated with previous unwanted pregnancy than current contraception. Contraceptive provision at OAT clinics may reduce incidence of unwanted pregnancy and NAS in Northeast Tennessee.

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Background: Fire fatality rates have decreased nationally while increasing in Tennessee. Individual characteristics affect the likelihood of fatality. Identification of populations sustaining greater proportions of fire fatality within the State will better inform regional fire prevention activities. Objectives: To compare individual characteristics of fatalities occurring in residential structure fires in Appalachian and Non-Appalachian counties of Tennessee. Methods: Analyses of residential structure fire fatality in Tennessee from 2005 to 2014 were conducted using Tennessee Fire Incident Reporting System data, comparing Appalachian and Non-Appalachian county regions. Analyses were restricted to incidents occurring in noninstitutionalized residential environments. Census data was used to identify county-level demographic characteristics. Direct adjustment for age effects between regions was performed. Results: There was no difference in proportion of fatalities between Appalachian (37.28%) and Non-Appalachian (36.27%) counties. Distribution of gender was similar between regions. A greater proportion of fatalities were aged 65 and older, compared to other age groups. Age- adjusted death rates were higher for Non-Appalachian (13.63/100,000) than Appalachian (11.18/100,000) counties. Age-specific death rates for persons younger than five years was greater in Appalachia (18.06/100,000 vs. 11.94/100,000), while age-specific death rates were greater among Non-Appalachian counties for persons aged 65 and older (37.23/100,000 vs. 19.75/100,000). A greater proportion of fire fatalities occurred in mobile homes in Appalachian counties (18.4%) than Non-Appalachian counties (11.3%). Conclusion:

Background: Heart failure (HF) is the leading cause of hospitalization among older adults in the United States. Health systems target readmission rates for quality improvement and cost reduction. Local Problem: Heart failure core measure (CM) scores at our medical center were lower than the national average, and methods for capturing the appropriate documentation on HF patients to ensure CM compliance were not clear. Methods: An interdisciplinary team determined barriers to increasing CM scores, gathered baseline data, and identified gaps in the existing process. Interventions: The team implemented an accurate reporting system and error-proofing process, redesigned the process for identifying patients admitted with a HF diagnosis, and developed a patient appointment section before discharge in the electronic medical record. Results: There was a decrease in readmissions within 30 days of implementation from 12% to 8%, and HF CM compliance score increased from 88% to 100%. The percentage of HF patients not identified during hospitalization decreased from 17% to 0%. Heart failure patients discharged with a 7-day follow-up appointment increased from 88% to 98%. Conclusion: Through implementation of an interdisciplinary-led process improvement and lean methodologies, metrics and CMs were achieved.

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