Purpose: Access to the full range of contraceptive options is essential to providing patient-centered reproductive health care. Women living in rural areas often experience more barriers to contraceptive care than women living in urban areas. Therefore, federally funded family planning clinics are important for ensuring women have access to contraceptive care, especially in rural areas. This study examines contraceptive provision, factors supporting contraceptive provision, and contraceptive utilization among federally funded family planning clinics in 2 Southern states. Methods: All health department and Federally Qualified Health Center clinics in Alabama and South Carolina that offer contraceptive services were surveyed in 2017-2018. Based on these surveys, we examined differences between rural and urban clinics in the following areas: clinic characteristics, services offered, staffing, staff training, policies, patient characteristics, contraceptive provision, and contraceptive utilization. Differences were assessed using Chi-square tests of independence for categorical variables and independent t-tests for continuous variables. Findings: Urban clinics had more staff on average than rural clinics, but rural clinics reported greater ease in recruiting and retaining family planning providers. Patient characteristics did not significantly vary between rural and urban clinics. While no significant differences were observed in the provision of long-acting reversible contraceptives (LARCs) overall, a greater proportion of patients in urban clinics utilized LARCs. Conclusions: While provision of most contraceptives is similar between rural and urban federally funded family planning clinics, important differences in other factors continue to result in women who receive care in rural clinics being less likely to choose LARC methods.

Engaging students in authentic research increases student knowledge, develops STEM skills, such as data analysis and scientific communication, and builds community. Creating authentic research opportunities in plant biology might be particularly crucial in addressing plant awareness disparity (PAD) (formerly known as plant blindness), producing graduates with botanical literacy, and preparing students for plant-focused careers. Our consortium created four CUREs (course-based undergraduate research experiences) focused on dual themes of plant biology and global change, designed to be utilized by early and late-career undergraduates across a variety of educational settings. We implemented these CURES for four semesters, in a total of 15 courses, at four institutions. Pre- and post-course assessments used the Affective Elements of Science Learning Questionnaire and parts of a "plant blindness" instrument to quantify changes in scientific self-efficacy, science values, scientific identity, and plant awareness or knowledge. The qualitative assessment also queried self-efficacy, science values, and scientific identity. Data revealed significant and positive shifts in awareness of and interest in plants across institutions. However, quantitative gains in self-efficacy and scientific identity were only found at two of four institutions tested. This project demonstrates that implementing plant CUREs can produce affective and cognitive gains across institutional types and course levels. Focusing on real-world research questions that capture students' imaginations and connect to their sense of place could create plant awareness while anchoring students in scientific identities. While simple interventions can alleviate PAD, implementing multiple CUREs per course, or focusing more on final CURE products, could promote larger and more consistent gains in student affect across institutions.

Immigrant clinicians are vital to population healthcare delivery and therefore population health. One in four physicians in the USA is foreign-born and notably represented in family and pediatric medicine—specialties charged with administering childhood/adolescent vaccines, such as human papillomavirus vaccine (HPVV). Our examination suggests there may be unique cultural and socialization factors that influence clinician HPVV recommendation practice; however, immigrant clinicians have not been adequately engaged within the national HPVV agenda. Given the volume and significance of immigrant clinicians, engagement of these clinicians, in both community and nation-wide efforts to increase HPVV, is a necessary step for improving and achieving the national health goal of optimizing HPVV for cancer prevention.

Purpose of Review: Electronic cigarettes (e-cigarettes) are gaining rapid popularity among all age groups, especially among youth. They have evolved into technologically advanced devices capable of delivering nicotine concentration and other substances. In addition to nicotine, e-cigarettes’ constituents possess variety of toxic chemicals that have adverse effects on human body. Recent Findings: In recent years, steady downward trend in tobacco usage has been observed; however, e-cigarette use is on upward trend. E-cigarettes are advertised as “safer” alternatives to conventional smoking and as an aid to smoking cessation. Emerging studies have, however, shown that e-cigarettes have harmful effects on the cardiovascular system and that most of the e-cigarette users are dual users, concurrently using e-cigarettes and smoking conventional cigarettes. Summary: Despite a gap in clinical studies and randomized trials analyzing adverse cardiovascular effects of e-cigarette use, the existing literature supports that different constituents of e-cigarettes such as nicotine, carbonyls, and particulate matters carry potential risk for cardiovascular diseases (CVD) on its users.

Objectives To describe the creation of a multigenerational linked dataset with social mobility measures for South Carolina (SC), as an example for states in the South and other areas of the country. Methods Using unique identifiers, we linked birth certificates along the maternal line using SC birth certificate data from 1989 to 2014, and compared the subset of records for which linking was possible with two comparison groups on sociodemographic and birth outcome measures. We created four multi-generational social mobility measures using maternal education, paternal education, presence of paternal information, and a summary score incorporating the prior three measures plus payment source for births after 2004. We compared social mobility measures by race/ethnicity. Results Of the 1,366,288 singleton birth certificates in SC from 1989 to 2014, we linked 103,194, resulting in 61,229 unique three-generation units. Mothers and fathers were younger and had lower education, and low birth weight was more common, in the multigenerational linked dataset than in the two comparison groups. Based on the social mobility summary score, only 6.3% of White families were always disadvantaged, compared to 30.4% of Black families and 13.2% of Hispanic families. Moreover, 32.8% of White families were upwardly mobile and 39.1% of Black families were upwardly mobile, but only 29.9% of Hispanic families were upwardly mobile. Conclusions for Practice When states are able to link individuals, birth certificate data may be an excellent source for examining population-level relationships between social mobility and adverse birth outcomes. Due to its location in the Deep South, the multigenerational SC dataset may be particularly useful for understanding racial/ethnic difference in social mobility and birth outcomes.

INTRODUCTION: E-cigarettes have emerged as the most commonly used tobacco or nicotine products among youth in the United States (US), and usage with other products (dual use) is not well understood. This study assessed dual use and identified associated factors of usage in school-going youth in the high tobacco burdened region of rural Appalachian Tennessee. METHODS: Two waves of data for the same cohort of students were collected in 2014 (Wave 1) and 2016 (Wave 2). Dual use of e-cigarettes with any other tobacco product was the dependent variable. The independent variables consisted of exposure to tobacco use at home, home smoking rules, smoking inside the vehicle, attitudes toward smoking, exposure to tobacco industry marketing/promotion, and peer/family pressure. Descriptive statistics and multivariate logistic regression analyses were conducted to determine the prevalence of dual use and delineate factors associated with usage. RESULTS: Dual use increased from 13.3% in Wave 1 to 18.6% in Wave 2. Results of logistic regression show that exposure to tobacco industry marketing/promotion was significantly associated with dual use in the two waves, odds ratio (OR) = 4.18 (confidence interval [CI] = 1.69-10.38) and OR = 4.43 (CI = 2.03-9.67), respectively. While allowing smoking inside the vehicles, sometimes, significantly increased dual use in Wave 1 (OR = 3.18 [CI = 1.19-8.48]), exposure to tobacco use at home (OR = 2.94 [1.24-6.97]), and peer/family pressure (OR = 2.92 [1.87-7.19]) increased usage in Wave 2. CONCLUSION: The increasing trend in dual use of e-cigarettes and other tobacco products among youth in Appalachia Tennessee suggests a critical need for comprehensive tobacco control programs to avert exacerbating disparities in tobacco use and tobacco-related diseases in the US.

Background: Disparities in tobacco use exist across regions in the United States. The Central Appalachian region carries some of the very high rates of tobacco use prevalence but research on tobacco use initiation is sparse. Objective: To investigate the intention to try tobacco and its associated factors among nonsmoking youth. Method: Data were obtained from school-based tobacco surveys (n = 539) conducted in 11 middle schools (6th–8th grades; aged 10–15 years) in Northeast Tennessee in 2015–2016. Nonsmoking participants without firm commitment to abstain from trying tobacco in the next year were considered to have an intention to try tobacco. The Full Information Maximum Likelihood estimation (FIML) method in Mplus was employed to conduct a multivariable logistic regression analysis to delineate correlates of intention to try tobacco. Results: Overall, 20.0% of participants had intention to try tobacco. Among participants with intention to try tobacco, 53.7% owned tobacco-branded item(s), 86.1% believed that tobacco users have more friends, and 88.9% lived with tobacco users. In the adjusted logistic model, ever use of tobacco products, home smoking rules, owning tobacco-branded item(s), living with tobacco users, believing that tobacco users have more friends, and perception of easy access to tobacco products were significantly associated with intention to try tobacco (p <.02). Conclusion: This study suggests that individual, interpersonal, and community level factors influence intention to try tobacco in this environment where tobacco pre-emption laws impede development of local tobacco control policies and regulations. Thus, efforts should focus on tobacco use initiation preventive programs, including school-based tobacco control programs.

The objective of this study was to investigate whether males who were born preterm took longer to receive a Duchenne muscular dystrophy diagnosis than term males. Data for males with Duchenne muscular dystrophy identified through a population-based surveillance system were analyzed using a Kaplan-Meier estimator. The first signs and symptoms were noted at a median age of 2 years in both groups. Median age when first signs and symptoms prompted medical evaluation was 2.59 years among preterm and 4.01 years among term males. Median age at definitive diagnosis was 4.25 years and 4.92 years for preterm and term males, respectively. Neither difference was statistically significant. Preterm males tended to be seen for their initial medical evaluation earlier than term males, though they were not diagnosed significantly earlier. It may take clinicians longer after the initial evaluation of preterm males to arrive at a Duchenne muscular dystrophy diagnosis.

In 2013, South Carolina implemented a multi-year program providing support services for pregnant and parenting teens. Local lead sites were responsible for coordinating service delivery in partnership with other multidisciplinary community-based organizations. We used social network theory and analyses (SNA) to examine changes in partnerships over time. Using two-stage purposeful sampling, we identified three lead sites and their self-reported community partners. We administered two web-based surveys grounded in social network theory that included questions about partnership relationships and organizational characteristics. We calculated selected whole-network measures (size, cohesion, equity, diversity). Following the Year 1 surveys, we reviewed our findings with the lead sites and suggested opportunities to strengthen their respective partnerships. Following the Year 3 surveys, we observed changes across the networks. Survey response rates were 91.5% (43/47) in Year 1 and 68.2% (45/66) in Year 3. By Year 3, the average network size increased from 15.6 to 20.3 organizations. By Year 3, one lead site doubled its measure of network cohesion (connectedness); another lead site doubled in size (capacity). A third lead site, highly dense in Year 1, increased in size but decreased in cohesion by Year 3. Innovative use of SNA findings can help community partnerships identify gaps in capacity or services and organizations needed to fulfill program aims. SNA findings can also improve partnership function by identifying opportunities to improve connectedness or reduce redundancies in program work. The ability of lead sites to strategically reconfigure partnerships can be important to program success and sustainability.

Objectives: To estimate prevalence and identify correlates of age of smoking initiation among adolescents in Africa. Methods: Data (n = 16,519) were obtained from nationally representative Global Youth Tobacco Surveys in nine West African countries. Study outcome was adolescents’ age of smoking initiation categorized into six groups: ≤7, 8 or 9, 10 or 11, 12 or 13, 14 or 15 and never-smoker. Explanatory variables included sex, parental or peer smoking behavior, exposure to tobacco industry promotions, and knowledge about smoking harm. Weighted multinomial logit models were conducted to determine correlates associated with adolescents’ age of smoking initiation. Results: Age of smoking initiation was as early as ≤7 years; prevalence estimates ranged from 0.7 % in Ghana at 10 or 11 years age to 9.6 % in Cote d’Ivoire at 12 or 13 years age. Males, exposures to parental or peer smoking, and industry promotions were identified as significant correlates. Conclusions: West African policymakers should adopt a preventive approach consistent with the World Health Organization Framework Convention on Tobacco Control to prevent an adolescent from initiating smoking and developing into future regular smokers.