Browsing by Author "Akpan, Idara N."
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Item Contraception use, perceived susceptibility to pregnancy, and pregnancy desire among women experiencing homelessness.(2022) Galvin, Annalynn M.; Garg, Ashvita; Griner, Stacey; Diener, Anelise; Akpan, Idara N.; Thompson, ErikaPurpose: Women experiencing homelessness are at higher risk of unintended pregnancy. While contraception may reduce unintended pregnancy rates, women experiencing homelessness have low rates of effective contraception use. In addition to access and affordability, how women perceive their susceptibility to pregnancy on contraception may also explain disparate rates of contraception use. This qualitative study aimed to explore how women experiencing homelessness perceive their susceptibility to pregnancy with and without contraception. Methods: From December 2019 - March 2020, semi-structured interviews (n=19) were conducted among pregnancy-capable (i.e., not sterilized), English-speaking women experiencing homelessness in Fort Worth, TX, 18-45 years of age, as part of a larger system-wide study investigating contraception preferences for women experiencing homelessness. Participants were recruited through flyers at local shelters, active recruitment through case managers, community partnerships, and snowball sampling. Interview questions included hypothetical perceived susceptibility to pregnancy while on and off contraception, pregnancy attitudes, and actual contraception use. Interviews were audio-recorded, transcribed, and analyzed using a seven-step framework method for coding and theme identification. This study was approved by the North Texas Regional Institutional Review Board. Results: Women had a mean age of 33.4 years (SD=7.6 years), with reported race almost evenly split between Black (47%) and White (53%). Primary nighttime residence included emergency shelter (n=7), unsheltered locations (n=6), transitional housing (n=5), and rapid-rehousing (n=1). All but two women reported inconsistent or no contraception use. Most women were confident in general contraceptive efficacy and perceived low pregnancy susceptibility when using hypothetical contraception. Some women found their risk of pregnancy was equal with and without contraception based on perceptions of specific contraception efficacy (e.g., condoms versus pills); fertility and fecundity concerns; and high abstinence self-efficacy. When asked whether they would like to get pregnant in the next year, 47% said no (n=9), 21% said yes (n=4), and 32% said they did not know (n=6). All four participants who wanted to become pregnant in the next year did not report current contraception use at the time of the study. Most women who were unsure or not wanting pregnancy in the next year were also not using consistent contraception. Women who desired pregnancy in the next year or were uncertain of whether they wanted to get pregnant in the next year reported similar perceived susceptibility to pregnancy regardless of contraception use, compared to women not desiring pregnancy in the next year who had a higher perceived susceptibility to pregnancy without contraception and lower perceived susceptibility with contraception. Conclusions: Findings elucidate why some women experiencing homelessness may perceive similar pregnancy susceptibility with both contraception use and non-use. Given the need to have higher susceptibility to pregnancy without contraception use for consistent contraception uptake, findings may better explain lack of actual contraception use, preferences for contraception, and pregnancy desire. Understanding the interplay between perceived susceptibility to pregnancy, housing status, and pregnancy perceptions such as timing-based pregnancy intention can better promote contraception and pregnancy prevention for women experiencing homelessness who do not desire pregnancy.Item COVID-19 clinical trial participation and awareness in Texas(Informa UK Limited, trading as Taylor & Francis Group, 2024-04-25) Luningham, Justin M.; Akpan, Idara N.; Alkhatib, Sarah; Taskin, Tanjila; Desai, Palak; Vishwanatha, Jamboor K.; Thompson, Erika L.The COVID-19 pandemic required the rapid development of COVID-19 vaccines and treatments, necessitating quick yet representative clinical trial enrollment to evaluate these preventive measures. However, misinformation around the COVID-19 pandemic and general concerns about clinical trial participation in the U.S. hindered clinical trial enrollment. This study assessed awareness of, willingness to participate in, and enrollment in COVID-19 vaccine and treatment clinical trials in Texas. A quota sample of 1,089 Texas residents was collected online from June - July 2022. Respondents were asked if they were aware of, willing to participate in, and had enrolled in clinical trials for COVID-19 vaccines or treatments. Overall, 45.8% of respondents reported being aware of clinical trials for COVID-19 treatments or vaccines, but only 21.7% knew how to enroll and only 13.2% had enrolled in a COVID-19 clinical trial. Respondents with bachelor's or graduate degrees were more likely to be aware of clinical trials, more likely to have enrolled in trials, and more willing to participate in treatment trials. Women were less willing to participate and less likely to have enrolled in COVID-19 clinical trials than men. Respondents aged 55 years and older were more willing to participate, but less likely to have enrolled in COVID-19 clinical trials than 18-to-24-year-olds. Common reasons given for not participating in clinical trials included concerns that COVID-19 treatments may not be safe, government distrust, and uncertainty about what clinical trial participation would entail. Substantial progress is needed to build community awareness and increase enrollment in clinical trials.Item Demographic and Psychosocial Correlates of COVID-19 Vaccination Status among a Statewide Sample in Texas(MDPI, 2023-04-28) Luningham, Justin M.; Akpan, Idara N.; Taskin, Tanjila; Alkhatib, Sarah A.; Vishwanatha, Jamboor K.; Thompson, Erika L.The COVID-19 pandemic has been a global public health concern since early 2020 and has required local and state-level responses in the United States. There were several Food and Drug Administration (FDA) approved vaccines available for the prevention of COVID-19 as of August 2022, yet not all states have achieved high vaccination coverage. Texas is a particularly unique state with a history of opposing vaccination mandates, as well as a large and ethnically/racially diverse population. This study explored the demographic and psychosocial correlates of COVID-19 vaccinations among a statewide sample in Texas. A quota sample of 1089 individuals was surveyed online from June-July 2022. The primary outcome in this study was COVID-19 vaccination status (fully vaccinated, partially vaccinated, or unvaccinated) and included independent variables related to demographics, COVID-19 infection/vaccine attitudes and beliefs, and challenges related to the COVID-19 pandemic. Hispanic/Latinx individuals were more likely than non-Hispanic White individuals to be partially vaccinated as opposed to unvaccinated. Higher education levels and confidence that the FDA would ensure a safe COVID-19 vaccine were strongly associated with a higher likelihood of being fully vaccinated. In addition, some challenges brought on by the pandemic and concerns about becoming infected or infecting others were associated with a higher likelihood of being partially or fully vaccinated. These findings emphasize the need to further investigate the interaction between individual and contextual factors in improving COVID-19 vaccination rates, especially among vulnerable and disadvantaged populations.Item The Effect of Trusted News Sources on the Confidence in the Safety of COVID-19 Vaccination(2023) Alkhatib, Sarah A.; Luningham, Justin M.; Akpan, Idara N.; Taskin, Tanjila; Vishwanatha, Jamboor K.; Thompson, Erika L.Purpose: COVID-19 vaccination prevents severe disease manifestations; yet uptake has been suboptimal. Confidence in the safety and efficacy of the vaccine influences COVID-19 vaccination decisions. Exposure to information from a trusted news source can impact perceptions and may contribute to vaccine decisions. This study assessed the association between trusted news sources and confidence in the safety of COVID-19 vaccination among Texas adults. Methods: Participants were recruited through an online panel using quota sampling based on the racial and ethnic distribution of Texas in July 2022 (n=1089). The primary predictor variable was self-reported trusted news sources for COVID-19 related news (16 options), in which respondents were asked to endorse any news source they trusted, with options ranging from print media to cable news to local news. The outcome was confidence in the safety of the COVID-19 vaccine (not at all confident to very confident). Multinomial regression analyses were conducted to model confidence in COVID-19 vaccination and trusted news sources while controlling for education, age, gender, and self-reported race. Results: Through an initial descriptive analysis, Fox News, local cable TV programs, and news broadcasting from one’s home abroad were associated with lower confidence levels. After grouping those three sources as "top news sources” and assessing their effect on confidence through a multinomial model, it was found that individuals who trusted those top sources were significantly less likely to endorse "somewhat confident” (OR=0.59, 95%CI 0.4-0.89) or "very confident” (OR=0.41, 95%CI 0.27- 0.62) compared to being "not at all confident” in the safety of the COVID-19 vaccine. Conclusions: Study findings show that some trusted news sources contributed to participants having less confidence or no confidence in the safety of the COVID-19 vaccine. Public health initiatives should consider how to address vaccine confidence among the public given the diversity of information sources people rely on.Item Effectiveness of provider communication training for increasing human papillomavirus vaccine initiation at a safety-net health system(Elsevier Inc., 2024-03-01) Meadows, Rachel J.; Gehr, Aaron W.; Lu, Yan; Maynard, Grace; Akpan, Idara N.; Taskin, Tanjila; Fulda, Kimberly G.; Patel, Divya; Matches, Sarah; Ojha, Rohit P.; Thompson, Erika L.BACKGROUND: Strong provider recommendation can increase uptake of human papillomavirus (HPV) vaccination. Therefore, we developed and implemented a provider education intervention on communication strategies for recommending HPV vaccination with clinic-level audit and feedback (HPV: Communicating about HPV to Adults and Teens [HPV CHAT]). We aimed to evaluate the effect of HPV CHAT on HPV vaccine uptake in seven family medicine and pediatric clinics in a large urban health system (USA). METHODS: We used a quasi-experimental design, where the eligible population included people aged 9-26 years with at least one encounter in June 2020-February 2023 at one of the participating community health clinics. We used interrupted time-series analysis to assess changes in the prevalence of HPV vaccine uptake. We used segmented Poisson regression with a log link function to estimate prevalence ratios (PR) and 95% confidence limits (CL) for level (immediate) and slope (over time) changes with adjustment for seasonality using Fourier transformation. RESULTS: Our study population comprised 60,328 observations in which the median age was 17 years (interquartile range: 13-21). A majority (58%) were female and 87% were racial/ethnic minorities. Overall, we observed no sizeable effect of the intervention on HPV vaccination uptake. Nonetheless, heterogeneity was observed by age group with modest increases in individuals aged 9-12 and 13-17 years. CONCLUSION: Our provider feedback intervention had minimal effect on increasing prevalence of HPV vaccination in seven family medicine and pediatric clinics. Novel strategies are needed to address provider barriers related to HPV vaccination.Item Information, Motivation, and Behavioral Skills for Contraception Use among Women Experiencing Homelessness(2022) Garg, Ashvita; Galvin, Annalynn; Diener, Anelise; Griner, Stacey; Akpan, Idara N.; Thompson, ErikaPurpose: Women experiencing homelessness have been reported to have higher rates of sexually transmitted infections, lower rates of contraceptive use, and higher rates of unintended pregnancies than stably housed women. Higher unintended pregnancy and lower contraceptive use in women experiencing homelessness warrant more research on behavioral cognitions for contraception access and utilization in this population. Assessing cognitions that affect contraception behaviors can be guided by utilizing a health behavior theory, such as the Information-Motivation-Behavioral (IMB) Skills model. Therefore, this study explored the IMB characteristics that play an important role in an individual's health behavior and could affect the contraception preferences among women experiencing homelessness. Methods: Semi-structured interviews (n=19) were conducted among women 18-45 years of age, not sterilized, English-speaking, and were currently experiencing homelessness. Women were recruited between December 2019 to March 2020 by convenience sampling through partnerships with local community organizations in Tarrant County. In-person or telephone interviews were conducted. Interviews were audio-recorded, transcribed, coded, and thematically analyzed based on the IMB framework. This study was approved by the North Texas Regional Institutional Review Board. Results: The mean age of women in the study sample was 33.4 years (SD = 7.6) and living situations included emergency shelters (37%), unsheltered locations (32%), transitional housing (26%), and rapid re-housing (5%). In the information construct, most women were aware of different contraceptive methods including intrauterine devices, implants, Depo shots, birth control pills, and condoms; however, many desired to learn more about the side effects of various methods. Additionally, some women had misconceptions regarding the possible side effects of different contraceptive methods. For motivation, most women (n=16) had negative attitudes regarding becoming pregnant at that time. Various reasons for not desiring to become pregnant included age, new responsibilities, presence of other children, finances, health concerns, negative beliefs about abortion, or risks involved with having a baby while being homeless. Additionally, most women had a positive attitude towards their current method of contraception, but their motivation to use a type of contraceptive method depended on side effects and comfort with the method. When examining behavioral skills, benefits and barriers to accessing contraception were inquired. Several women mentioned the better health insurance coverage for birth control would benefit them. Lack of adequate insurance coverage and transportation were the major barriers. Other barriers included financial constraints, not enough knowledge regarding how to use birth control, and not enough information knowing how to get an appointment or start the process of getting birth control. Conclusions: Findings highlight the information, motivation, and behavioral skills for contraception use among women experiencing homelessness. Improving knowledge about side effects of various contraceptive methods, addressing any misconceptions, and increasing accessibility to contraceptive methods by providing transportation and financial assistance while maintaining reproductive autonomy might be effective strategies to improve contraception uptake and reduce unintended pregnancies among women experiencing homelessness.Item The Role of Pregnancy Intention in the Choice of Contraception Among U.S. Women of Reproductive Age: 2017-2019 National Survey of Family Growth(2023) Akpan, Idara N.; Yockey, Andrew; Galvin, Annalynn; Thompson, ErikaPurpose: Contraceptive use is an important aspect of women’s reproductive health. Long-acting reversible contraceptives (LARCs) such as the intrauterine device and hormonal implant, are known to be highly-effective methods to prevent an unintended pregnancy. Pregnancy intention may contribute to contraception use, and women who do not intend to get pregnant may opt for effective contraception methods. However, pregnancy intention is a behavioral factor that is subject to change based on circumstances. This study describes contraception use by pregnancy intention among a nationally representative sample of U.S. women aged 15-49 years. Methods: The study sample included women aged 15-49 years from the 2017-2019 National Survey of Family Growth (n=3025). The dependent variable was current contraception method at the time of interview, operationalized into four categories: LARCs (reference category), pill/ring/patch/injectable, barrier methods, and no contraception. Pregnancy intention (in the future or after a current pregnancy) was operationalized as intending, not intending, and don’t know/refused. The relationship between pregnancy intention and current contraception method was examined using weighted, multinomial logistic regression analyses, adjusting for race, age group, and type of current health insurance coverage. Results: The mean age of the women was 29.6 years (SD=8.4 years), and women identified as White (67.6%), Black (24.2%), and Other (8.2%). Less than a third (29.6%) of the women had a bachelor’s degree or higher, and a majority (58.4%) of women had private insurance. Overall, 22.1% were currently using LARCs and 15.7% were using no contraception. Compared to women intending to get pregnant, women not intending to get pregnant had lower odds of using pill/ring/patch/injectable (aOR=0.57; 95%CI=0.41, 0.80), barrier methods (aOR=0.54; 95%CI=0.40, 0.73), and no contraception (aOR=0.40; 95%CI=0.25, 0.64) versus LARCs. Women aged 20-29 years had lower odds of using pill/ring/patch/injectable (aOR=0.41; 95%CI=0.25, 0.67) and no contraception (aOR=0.43; 95%CI=0.24, 0.79) versus LARCs, compared with women aged 15-19 years. Older women within the age group 40-49 had higher odds of using barrier methods (aOR=1.98; 95%CI=1.05, 3.73) and significantly lower odds of using pill/ring/patch/injectable (aOR=0.32; 95%CI=0.18, 0.57) versus LARCs, compared with women aged 15-19 years. Compared to women with private insurance, women with public insurance (Medicaid/Children’s Health Insurance Program) had lower odds of using pill/ring/patch/injectable (aOR=0.50; 95%CI=0.35, 0.72) versus LARCs. Conclusions: Overall, women not intending to get pregnant were less likely to use pill/ring/patch/injectable and barrier methods compared to LARCs. As such, women who desire to prevent unintended pregnancy may opt for LARCs. Findings also show that a proportion of women not intending to get pregnant were not using any method of contraception, which highlights the need to examine reasons for no contraceptive use among this group of women. Given that pregnancy intention can be dynamic, preconception care should be accessible to women to support them in making informed decisions about their reproductive health. Moreover, there is need to examine factors that impact decision-making on contraception methods while accounting for pregnancy intention.Item The Impact of the Lay Health Educator (LHE) Model on Hepatitis B Screening among the Refugee Population(2020) Acharya, Rushil; Raines-Milenkov, Amy; Felini, Martha; Baker, Eva; Akpan, Idara N.Purpose: Hepatitis B (HBV) is a viral infection affecting the liver which may lead to acute and chronic diseases such as cirrhosis and liver cancer. Although refugees are required to screen for hepatitis B at the time of arrival in the U.S., many of them are not aware of their hepatitis B results and there are gaps in follow-up care for individuals who test positive. The Building Bridges program responds to this unmet need through hepatitis B education, screening and navigation to follow-up clinical care. This study aims to evaluate the impact of Building Bridges lay health educator (LHE) model as an approach to increase hepatitis B screening among the refugee population. Methods: A cross-sectional analysis of HBV screening was conducted among the refugee population enrolled in the Building Bridges program from 2014 to 2020. Statistical analysis was performed using Microsoft Excel and Statistical Analysis System (SAS). Hepatitis B screening completion rates were calculated. Results: 1053 female and male enrolled refugees were asked about previous hepatitis B screening. 717 participants were eligible, of those, 680 participants were never screened. At post enrollment, 303 participants received hepatitis B screening. Conclusions: The LHE model helped to increase Hepatitis B screening. Lay health educators play significant roles in facilitating access to health care. There is need for more research on the impact of the LHE model in motivating the need for preventive health screening. More research is needed to understand why some participants did not choose to be screened.Item Willingness of a Multiethnic Immigrant Population to Donate Biospecimens for Research Purposes(Springer Nature, 2021-07-26) Raines-Milenkov, Amy; Felini, Martha; Baker, Eva; Acharya, Rushil; Longanga Diese, Elvis; Onsa, Sara; Iang, Hlawn; Abdi, Anab; Akpan, Idara N.; Hussain, Arbaz; Wagner, Teresa; Hughes, JonathanThis cross-sectional study explores the willingness to donate biospecimens for research purposes among six refugee communities in North Texas (spanning Myanmar, Central Africa, Somalia, Nepal, Arabic speaking countries, and others). Participants were asked four questions about biospecimen donation: (1) previously asked to donate, (2) ever agreed to donate, (3) willingness to donate for future research, and (4) what samples they would be willing to donate. Most participants (77%) were willing to donate biosamples for medical research; 58% were willing to donate samples. Fewer refugees from Somalia were willing to donate compared to immigrants from Myanmar, Central Africa, and Nepal (p < 0.01). Participants in the older age group (40 + years) were 3.2 times more likely to be willing for donation of biospecimens than the younger ones (OR 3.22, 95% CI 1.22, 8.55). Findings suggest refugees' willingness to participate in biospecimen donation which support intentional inclusion of multicultural populations into medical research.