Research and Publications - Department of Obstetrics and Gynecology
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Item Abortion at 12 or more weeks' gestation and travel for later abortion care among Mississippi residents(Elsevier, 2022) White, Kari; Sierra, Gracia; Evans, Teairra; Roberts, Sarah C. M.; University of Texas Austin; University of Alabama Tuscaloosa; University of California BerkeleyObjective: To assess the association between indicators of economic disadvantage and geographic accessibility of reproductive health services and abortions >= 12 weeks' gestation in Mississippi. Study Design: This cross-sectional study used data on Mississippi residents who obtained abortion care from 12 of 14 facilities in Mississippi, Alabama, Louisiana, and Tennessee in 2018. We estimated logistic regression models to assess the association between levels of county deprivation, the number of obstetrician and/or gynecologists per 10,00 0 women, and one way distance to the nearest facility with having an abortion >= 12 weeks' gestation. We compared the median one-way distance to the facility where patients < 12 weeks', 12-15 weeks', and >= 16 weeks' gestation received care, using Kruskal-Wallis tests. Results: Of the 4,455 Mississippi residents who obtained abortions, 73% were Black, 59% lived >= 50 miles from a facility, and 60% obtained care in Mississippi. Overall, 764 (17.2%) abortions were performed >= 12 weeks' gestation. In adjusted models, those in counties with moderate (OR, 1.47; 95% CI: 1.15-1.90) and high (OR: 1.36, 95% CI: 1.01-1.83) (vs low) levels of economic deprivation and counties with 0.1-1.4 (vs >= 2.5) obstetrician/gynecologists per 10,000 women (OR: 1.55; 95% CI: 1.06-2.27) had higher odds of obtaining an abortion >= 12 weeks' gestation. Mississippi residents who obtained abortions >= 16 weeks' gestation traveled a median 143 miles one way to the facility where they received care, compared to 69 miles and 60 miles traveled by those < 12 weeks' and 12-15 weeks' gestation, respectively (p < .001). Conclusions: Many Mississippi residents obtained abortion care >= 12 weeks' gestation, which is related to greater economic constraints and limited geographic access to reproductive health services. (C) 2021 Elsevier Inc. All rights reserved.Item Evidence of Help-Seeking Behaviors Among Black Women Under Community Supervision in New York City: A Plea for Culturally Tailored Intimate Partner Violence Interventions(Mary Ann Liebert, 2022) Goddard-Eckrich, Dawn; Henry, Brandy F.; Sardana, Srishti; Thomas, Brittany, V; Richer, Ariel; Hunt, Timothy; Chang, Mingway; Johnson, Karen; Gilbert, Louisa; Columbia University; Pennsylvania State University; Pennsylvania State University - University Park; University of Alabama Tuscaloosa; Johns Hopkins University; Johns Hopkins Bloomberg School of Public HealthBackground: Black women involved in the legal system disproportionately experience intimate partner violence (IPV); however, current research does not satisfactorily describe the risk and protective factors associated with IPV among Black women under community supervision.Methods: We conducted a subgroup analysis of Black women (N = 128) using data from a randomized controlled trial that evaluated the feasibility and efficacy of two IPV screening and prevention programs for women under community supervision. Participants in the original study were randomized into two IPV prevention conditions-computerized or case manager Women Initiating New Goals of Safety (WINGS). In this study, we examine the effects of that study's two conditions on linkage to IPV services and secondary outcomes, specifically among Black participants who experienced physical, sexual, and psychological IPV.Results: Both conditions showed significant reductions in days of substance use abstinence over the 3-month period among Black women who experienced sexual or verbal IPV. Participants in the case manager arm were 14 times more likely to receive IPV services in the past 90 days-from baseline to the 3-month follow-up (adjusted odds ratio = 14.45, 95% confidence interval [CI] = 1.25 to 166.51, p = 0.032). Participants in the computerized arm were significantly more likely to report receiving social support from baseline to the 3-month follow-up assessment (regression coefficient [b] = 2.27, 95% CI = 0.43 to 4.11, p = 0.015).Conclusions: Although both conditions showed significant reductions in the number of days of abstinence from substance use among this subgroup of Black women, the findings showed differential effectiveness between the computerized WINGS arm and the case manager WINGS arm in improving social support and linkage to services. These findings may indicate that different modalities of WINGS may work better for specific activities and point to the need for a hybrid format that optimizes the use of distinct modalities for delivering activities.Item Healthcare experiences of urban young adult lesbians(Sage, 2020) Griffin, Marybec; Jaiswal, Jessica; Krytusa, Dawn; Krause, Kristen D.; Kapadia, Farzana; Halkitis, Perry N.; Rutgers State University New Brunswick; Rutgers State University Newark; University of Alabama Tuscaloosa; Rutgers State University Medical Center; New York University; NYU Langone Medical CenterPurpose: This cross-sectional study of young adult lesbians explores their healthcare experiences including having a primary care provider, forgone care, knowledge of where to obtain Pap testing, and sexually transmitted infection testing. Methods: Quantitative surveys were conducted at lesbian, gay, bisexual, and transgender venues and events with a sample of 100 young adult lesbians in New York City between June and October 2016. Using the Andersen model of healthcare access, this study examined associations between sociodemographic characteristics and healthcare experiences using multivariable logistic regression models. Results: Having a primary care provider was associated with having health insurance (adjusted odds ratio (AOR) = 4.9, p < 0.05). Both insurance (AOR = 0.2, p < 0.05) and employment (AOR = 0.2, p < 0.05) status were protective against foregone care among young adult lesbians. Disclosure of sexual orientation to a provider improved knowledge of where to access Pap testing (AOR = 7.5, p < 0.05). Disclosure of sexual orientation to friends and family improved knowledge of where to access sexually transmitted infection testing (AOR = 3.6, p < 0.05). Conclusion: Socioeconomic factors are significantly associated with healthcare access among young adult lesbians in New York City. Maintaining non-discrimination protections for both healthcare services and insurance coverage are important for this population. In addition, financial subsidies that lower the cost of health insurance coverage may also help improve healthcare access among young adult lesbians.Item Pilot study of a condensed communication skills workshop for gynecologic oncology fellows(Elsevier, 2019) Urban, Renata R.; Fay, Emily E.; Podgurski, Lisa; Bevis, Kerri; Carey, Elise C.; Lefkowits, Carolyn; Amory, Josephine; University of Washington; University of Washington Seattle; University of Alabama Tuscaloosa; Mayo Clinic; University of DenverIn gynecologic oncology (GO) fellowship, devoting sufficient time to learning communication skills can be challenging due to required time and logistics. A two day workshop was previously piloted at a single institution with GOs and found to be beneficial. We sought to implement that curriculum in a condensed form. We conducted two four-hour sessions with 4 GO fellows at a single institution over 4 months. Sessions consisted of a didactic in communication skills led by faculty with VitalTalk (TM) training, followed by application with a simulated patient. Cases were developed and previously used in a two-day workshop at another institution. Fellows were surveyed prior to both sessions and after the second session. Perceived confidence was assessed on a Likert scale (1 to 5). An improvement was defined by an increase of >= 1 in Likert score. All fellows reported that the educational quality of the sessions was "excellent," that the time in between sessions was "just right," allowing them to apply skills learned in the first session prior to the second. After both sessions, at least three of the four fellows reported an improvement in confidence in nearly 50% (10/21) of the communication topics assessed. GO fellows perceived improvements in communication skills with condensed half-day training seminars.Item Quantitative assessment of nutritive sucking patterns in preterm infants(Elsevier, 2020) Salas, Ariel A.; Meads, Claire; Ganus, Shae; Bhatia, Anisha; Taylor, Caitlin; Chandler-Laney, Paula; Imtiaz, Masudul H.; Sazonov, Edward; University of Alabama Birmingham; University of Alabama TuscaloosaObjective: To assess patterns of nutritive sucking in very preterm infants <= 32 weeks of gestation. Study design: Very preterm infants who attained independent oral feeding were prospectively assessed with an instrumented feeding bottle that measures nutritive sucking. The primary outcome measure was nutritive sucking performance at independent oral feeding. Result: We assessed nutritive sucking patterns in 33 very preterm infants. We recorded 63 feeding sessions. The median number of sucks was 784 (IQR: 550-1053), the median sucking rate was 36/min (IQR: 27-55), and the median number of sucking bursts during the first 5 min of oral feeding was 14 (IQR: 12-16). Maximum sucking strength correlated with the number of sucks (r = 0.62; p < 0.01). No safety concerns were identified during the study. Conclusion: The quantitative analysis of nutritive sucking patterns with a newly developed instrumented bottle in stable, very preterm infants is safe and feasible. More research is needed to develop and refine the instrument further.Item The Prevention of Post-Operative Gynecological Psychoses(Atlanta Medical Journal Co., 1912) Cole, Herbert P.