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Background: The use of long-acting reversible contraceptive (LARC) methods, such as intrauterine devices (IUDs) and implants has demonstrated high effectiveness in preventing pregnancy. While LARC use in Title X programs has increased over the past decade, little is know about the extent to which gains are occurring uniformly across states. Methods: We examined state-level changes in LARC use among Title X clients between 2012 and 2016 using a repeated cross-sectional study design. States were characterized by the proportion of reproductive age women in need of publicly funded contraception. Variation in LARC use by level of need was examined using GEE models. Results: Across all states, LARC use in Title X clinics increased from 9.1% to 16.2% during the study period. In 2012, LARC use in the states with the highest and lowest level of need differed by 2.3 percentage points (7.8% compared to 10.1%). By 2015 the gap in LARC use between high and low need states widened to reach 5.3 percentage points, more than double what was observed in 2012. However, by 2016 the margin of the gap narrowed. Conclusions: Observed increases in LARC use among states with the highest level of need for publically funded services are much lower than what is observed among states with the lowest level of need. However, we did find this gap is narrowing. This finding is important given states with greater need are those with higher proportions of low-income and younger women who are at greater risk for experiencing unintended pregnancies.

Background: Unintended pregnancies remain an important public health issue. Modern contraception is an important clinical service for reducing unintended pregnancy. This study examines contraception use among a representative sample of women residing in two southeastern U.S. states. Methods: A cross-sectional statewide survey assessing women's contraceptive use and reproductive health experiences was conducted in Alabama and South Carolina. Characteristics of the study population were compared across contraceptive use categories and multivariable regression analysis was performed examining relationships between covariates of interest and contraceptive use outcomes. Results: Approximately 3,775 women were included in the study population. Overall, 26.5% of women reported not using any contraception. Short-acting hormonal methods were the most commonly reported (26.3%), followed by permanent methods (24.4%), long-acting reversible contraception (LARC; 14.3%), and barrier/other methods (8.5%). Nonuse was more prevalent among women with some college or an associate's degree, incomes between $25,000 and $50,000, no health insurance, and longer gaps in care. LARC use among women with Medicaid as a pay source was higher than use among privately insured women and higher in South Carolina than Alabama. Both nonuse and LARC use were higher among women with no insurance. Conclusions: Study findings are largely consistent with previous research using similar population-based surveys. LARC use was higher among the study population relative to what is observed nationally. Factors enabling access to contraceptive services, particularly for lower income women, were associated with contraception use patterns. These findings provide important context for understanding individuals’ access to resources and are important for fostering increased access to contraceptive services among women in these two states.

Introduction: There is no known safe level of secondhand smoke exposure; yet, less than 30% of the global population is covered by comprehensive smoke-free policies as of 2016 and there are few smoke-free policies in sub-Saharan Africa (SSA).This study examines the support for smoke-free public places in SSA and delineates their correlates. Methods: Data collected through the Global Adult Tobacco Survey (2012–2017) were analyzed using SAS for descriptive and multivariable analyses, with a significance level set at p < .05. Results: No SSA country had comprehensive smoke-free policies, defined as a prohibition of smoking in eight public places. In the four countries whose Global Adult Tobacco Survey data were analyzed (Nigeria, Cameroon, Kenya, and Uganda), support for the prohibition of smoking in public places was over 90% in all eight public places except bars. Support for smoking prohibition in bars was 65.8%, 81.1%, 81.4%, and 91.0% in Nigeria, Cameroon, Kenya, and Uganda, respectively. Factors associated with support for smoke-free bars differed across the four countries, but in all countries, current smokers had decreased odds of support for smoke-free bars. Knowledge of secondhand smoke harm and living in smoke-free homes were associated with increased odds of support for smoke-free bars in all countries except Kenya. Conclusion: The high support for smoke-free public places should inform the efforts of the public health community and policymakers in these four SSA countries toward meeting their obligations of Article 8 of theWorld Health Organization Framework Convention onTobacco Control (WHO FCTC). Implications: Much of the population in SSA is not protected by comprehensive smoke-free policies. It was found that the overwhelming majority of adults in four large countries in SSA support the prohibition of smoking in public places and that knowledge of the health dangers of smoking and exposure to secondhand smoke and home smoking rules increased support for the prohibition. High support for the prohibition of smoking in these four SSA countries suggests tobacco control proponents should advocate for comprehensive smoke-free policies.

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OBJECTIVE: Mental health outcomes such as attention-deficit/hyperactivity disorder (ADHD), behavior disorders, anxiety, depression, and adverse childhood experiences (ACEs) are common disorders among children in the United States. Little is known on how potential resilient factors may moderate the relationship between exposure to ACEs and mental health outcomes. This study examines associations between ACEs and resilience on mental health outcomes using the 2018 National Survey of Children's Health (N = 26,572). METHOD: Logistic regression and interactions examined the association between ACEs, resilience, and mental health outcomes. ACE exposure and low resiliency were associated with an increased likelihood of mental health outcomes. RESULTS: There were significant interactions between exposure to ACEs and family resilience as well as significant interactions between ACE exposure and community resilience. On stratification, the presence of individual resilience and having all resilience measures decreased the odds of ADHD, behavioral disorders, anxiety, and depression and the presence of community resilience decreased the odds of depression among individuals who had experienced 4 or more ACEs. CONCLUSION: These results illustrate the need to promote resilience measures for tackling mental health problems and reducing the negative effect of trauma in children.

CONTEXT: The Foundational Public Health Services (FPHS) include a core set of activities that every health department should be able to provide in order to ensure that each resident has access to foundational services that protect and preserve health. Estimates of the public health workforce necessary to provide the FPHS are needed. OBJECTIVE: This study assessed the potential use of an FPHS calculator to assess health department workforce needs. DESIGN AND SETTING: Qualitative interviews were conducted via Zoom in December 2020-January 2021. PARTICIPANTS: Seventeen state and local public health leaders. MAIN OUTCOME MEASURES: Qualitative insights into the potential use of an FPHS calculator. RESULTS: Almost all participants expressed that a reliable estimate would help them justify requests for new staff and that a calculator based on the FPHS would help organizations to critically assess whether they are meeting the needs of their communities and the core expectations of public health. Although participants expected that a tool to calculate full-time equivalent needs by the FPHS would be helpful, some participants expressed concerns in regard to using the tool, given ongoing workforce issues such as recruitment challenges, hiring freezes, and funding restrictions. An anticipated positive consequence of using this tool was that it may lead to cross-training the workforce and result in more diverse expertise and skills among existing workers. The other unintended consequences were that an FPHS calculator would require a substantial amount of time assessing the current FPHS efforts of existing staff and the results of the FPHS gap estimate could become the bar rather than the minimum needed. CONCLUSIONS: The current public and political focus on public health infrastructure as a result of the COVID-19 pandemic has created a window of opportunity to create change. An FPHS-based staffing tool may help transform public health and initiate a new era.

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Magister Scientiae - MSc / The aim of this study was to examine the extent to which providers' practices affect the cost of hospital procedures incurred by patients. The spsecific objective was to explore the magnitude of variations and statistically establish the significance of relationships between admission/specialist costs incurred by patients for four major procedures and the hospital group, geographical location, employer group and demmographic realted risk profiles. The study contributes to a better understanding of the way in which managed care companies could channel beneficiaries of medical schemes to efficient providers. / South Africa