Browsing by Author "Thompson, Erika"
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Item A Systems Approach to Postpartum Depression: Opportunities for Prevention and Treatment(2019-03-05) Thompson, Erika; Adhikari, SujitaA Systems Approach to Postpartum Depression: Opportunities for Prevention and Treatment Sujita Adhikari MPH Candidate, Erika L. Thompson, PhD, MPH, CPH Dept. of Health Behavior and Health Systems, UNT Health Science Center, Fort Worth TX,76107 Background Postpartum Depression (PPD) is a common mental health issue that occurs in women after childbirth. The depressive symptoms in affected mother are often manifested as a feeling of extreme sadness, guilt, helplessness, insomnia, excessive crying, extreme concern about child, fatigue and suicidal thoughts. Biological factors (e.g. hormonal changes) and psychological factors (e.g. stress, lack of social support, low socio-economic status, abusive relationships, greater work pressure, the occurrence of adverse life events, previous history of depression) are risk factors for PPD. In 2018, 14.7% of women in Texas who gave live birth experienced postpartum depression. Due to the complexity of this health issue, systems thinking is necessary to identify organizations aligned with addressing PPD, which can then help design effective interventions to minimize the potentially harmful effects of PPD. Objective The main objective is to identify organizations in the Fort Worth region that are involved in postpartum depression prevention or treatment and map organization connections. Methodology A web search was conducted in November 2018 to identify organizations and government bodies who address postpartum depression. Interconnection was established amongst these organizations to analyze using a system thinking approach. Results Three national-level organizations (e.g. Medicaid), four state-level organizations (e.g. Texas Department of Health and Human Services) and three local level organizations (e.g. MHMR of Tarrant County) were identified in the Fort Worth region. These organizations when analyzed were found connected with each other forming a system which operated to address PPD in this region. Conclusion These major ten organizations that are dedicated to working on postpartum depression are interconnected. The organizations operate at different levels to form a complex system. While organizations are making a positive impact on this issue, it is still necessary to dive deeper and understand the underlying factors for this problem. By understanding the complex system for PPD prevention and opportunities for integration, better mental health outcomes can be achieved.Item Adolescent Health Data: Feelings of Depression and Marijuana Use(2019-03-05) Thompson, Erika; Davis, AmbrialeAdolescent Health Data: Feelings of Depression and Marijuana Use Objective The purpose of this study is to examine an association between feelings of depression and marijuana use amongst high school students in the United States. Methods Data were analyzed based on the Youth Risk Behavior Surveillance System (YRBS), 2017. SAS 9.4 was used to apply survey weighting procedures to the bivariate and logistic regression models as well as to calculate univariate and bivariate descriptive statistics, and crude and adjusted odds ratios for the outcome, exposure, and covariates (n=13,916). Outcome was measured as “During the past 12 months, did you ever feel so sad or hopeless almost every day for two weeks or more in a row that you stopped doing some usual activities” and operationalized by yes/no. Exposure was measured by ““during your life, how many times have you used marijuana” and operationalized as no if zero and yes if any other number. Results Students who had feelings of depression were more likely to have ever used marijuana (49.1%) than those who did not have feelings of depression (29.4%). Also, females were more likely to have experienced feelings of depression when compared to males, 67.2% and 32.8% respectively. High school students who ever tried marijuana had 2.46(95% CI:2.15-2.82) times the odds of feeling depressed compared to those who had never tried marijuana. Female students had 2.73(95% CI:2.37-3.13) times the odds of feeling depressed compared to male students. Black or African American, 0.83(95% CI:0.69-0.99), and 15 year old, 0.78(95% CI:0.64-0.96), students had less odds than whites and those 17 years and older respectively. Conclusions This study revealed that students who had feelings of depression were more likely to have ever used marijuana compared to students that did not. Race and age were protective factors for depression. Female students had almost three times the odds of feeling depressed than males. Results can inform future research surrounding attitudes of marijuana use among high school students with feelings of depression in order to prevent or delay marijuana use in this population.Item An Assessment of Obesity and Sleep Sufficiency Among Adolescents in the United States(2019-03-05) Thompson, Erika; Mayfield, LauraAn Assessment of Obesity and Sleep Sufficiency Among Adolescents in the United States Laura Mayfield, MPH Candidate, CHES Erika Thompson, PhD, MPH, CPH Purpose: Obesity is increasing among adolescents in the US, and understanding co-factors is needed. Insufficient sleep may contribute to obesity among adolescents. The purpose of this study was to assess the association between sufficient sleep and obesity among 9th-12th grade students in the United States. Methods: This study used the 2017 Youth Risk Behavior Surveillance System data (N=14,765). The sample was further restricted as a complete case analysis (N=10,350). The outcome was obesity, which was categorized dichotomously (obese, not obese) based on participants’ Body Mass Index. The exposure was sleep: those who got 8 or more hours of sleep on the average school night (sufficient sleep) and those who did not (insufficient sleep). Covariates included physical activity, sex, age, and race/ethnicity. All analyses were completed using survey- weighted procedures in SAS 9.4. A survey logistic regression model was used to calculate adjusted odds ratios and 95% confidence intervals modeling odds of obesity. Results: Among participants, 14.7% were obese and 74.5% had insufficient sleep. The association between sleep and obesity was not statistically significant (OR=0.91, 95% CI 0.76, 1.08). However, participants who were physically active for 60 minutes, 5 or more days each week, were less likely to be obese compared to participants who were not physically active, while controlling for sleep, sex, age, and race/ethnicity (OR=0.65, 95% CI 0.55, 0.76) Conclusions: Multiple factors are associated with obesity among American adolescents. Further research on obesity trends and associated factors is needed to help inform public health efforts to prevent and reduce obesity among adolescents. Keywords: YRBSS, Sleep, ObesityItem An Assessment of Texas Human Papillomavirus Vaccination Rates(2020) Thompson, Erika; Hoff, BrandonPurpose: Previous studies have demonstrated significant differences in Human papillomavirus (HPV) vaccine rates between different regions of the US. However, an analysis of geographic variation of HPV vaccine uptake among different areas of Texas has not been investigated yet. This study examines the geographical variation in HPV vaccine rates within Texas. Methods: This cross-sectional study was conducted using data from the National Immunization Survey and Teen, 2017 (N=20,949). Logistic regression was used to model provider-verified HPV vaccination up-to-date status predicted by area of residence within Texas, while adjusting for the effects of sex, race/ethnicity, maternal education level, household income, and type of health insurance. Results: Approximately 42% of adolescents in Texas were up-to-date on the HPV vaccine, compared to 52% of adolescents in the US as a whole. Adolescents who lived in El Paso County [OR = 2.79, (95% CI: 1.86, 4.18)] or the City of Houston [OR = 2.04 (95% CI: 1.30, 3.21)] were more likely to be up-to-date on the HPV vaccine than adolescents who lived in other areas of Texas. Conclusion: The results of this study indicate a difference in HPV vaccine rates across different areas of Texas. Most previous research on regional differences among US adolescents attributed much of the variation to state-level policies. The results of this study suggest that there may be other factors contributing to HPV vaccine disparity within Texas and further research should be conducted to elucidate these factors.Item ASSESSING REPRODUCTIVE INTERCONCEPTION CARE BEHAVIORS, BARRIERS, AND FACILITATORS AMONG WOMEN RECENTLY PREGNANT AND HOMELESS(2022-08) Galvin, Annalynn M.; Thompson, Erika; Lewis, Melissa; Walters, Scott T.Interconception care, care provided to mothers between pregnancies, reduces short birth interval risks such as prematurity and low birthweight. Women experiencing homelessness have higher rates of unintended pregnancy and may experience stronger benefits from reproductive interconception care through either unintended pregnancy reductions or healthy pregnancy promotion via family planning. It is critical to build on limited research on interconception care within this population to potentially reduce poverty and cyclical, intergenerational homelessness. By utilizing a sequential explanatory mixed-methods design, this proposed study aimed to first determine prevalence ratios of interconception behaviors such as attendance of maternal postpartum visits, birth spacing and family planning counseling, and postpartum contraception outcomes of women experiencing homelessness, then identify the most salient interconception barriers and facilitators related to interconception information (e.g., knowledge), motivation (e.g., personal attitudes), and behavioral skills (e.g., perceived self-efficacy) among postpartum women who experienced homelessness during pregnancy. Using the 2016-2019 Pregnancy Risk Assessment and Monitoring System, the prevalence of interconception care behaviors among women experiencing homelessness and the associations between housing status and interconception care behaviors were estimated. The sample (n=100,706) was primarily non-Hispanic White (59.4%), married (61.9%) women with private insurance (59.4%) and less than a 4-year degree (63.0%). Approximately 2.4% of participants experienced housing instability in the 12 months before their child was born. Perinatal housing instability was significantly associated with lower odds of attending a postpartum maternal visit (aOR=0.45, 95% CI 0.37, 0.56) and (aOR=1.30, 95% CI 1.07, 1.57) when compared to women who did not experience homelessness in the last 12 months from the time of the interview. Findings from aim 1 determined specific interconception care behavior deficits to further explore via one-hour semi-structured interviews with 12 women experiencing homelessness while pregnant who had given birth within the last four years. Eligible women were recruited through local agency partnerships using purposive sampling. Interviews were audio-recorded, coded to consensus, and analyzed for themes. Information-related themes included knowledge and misconceptions about perinatal processes (e.g., pregnancy, labor and delivery, becoming pregnant, preventing pregnancy) as well as information-seeking themes. Motivation-related themes included attitudes about recent interconception care experiences, perinatal social influences, perceived susceptibility to future pregnancy, and attitudes regarding reasons for not engaging in postpartum pregnancy prevention. Behavioral skill-related themes included objective ability to engage in perinatal behaviors during housing instability, as well as perceived self-efficacy related to barriers and facilitators to engaging in reproductive interconception pregnancies as well as ease of pregnancy. Macro-related themes included housing effects on perinatal period, how perinatal experiences affected seeking stable housing, and how the interconnected nature of housing and other macro-level factors influenced reproductive interconception care. These findings establish a baseline understanding of interconception behaviors and the associated barriers and facilitators related to interconception care information, motivation, and behavioral skills among women experiencing homelessness. Findings may potentially strengthen current interconception practices and augment reductions in unintended pregnancy, short birth intervals, or adverse birth outcomes in future pregnancies, thus improving pregnancy outcomes and improving the health of women before, during, and after pregnancy.Item Assessing the impact of targeted continuing education training on improving dental hygienists’ HPV-related knowledge(2023) Farris, Alexandra; Neelamegam, Malinee; Cotter, Jane; Dickinson, Charlene; Johnson, Kaeli; Kline, Nolan; Thompson, Erika; Griner, StaceyBackground Human papillomavirus (HPV) is the most prevalent sexually transmitted infection in the United States and is attributable to various cancers. Approximately 70% of oropharyngeal cancer diagnoses are linked with an HPV infection. HPV vaccination is an effective prevention method that can protect against multiple high-risk strains including those directly associated with oropharyngeal cancer. Given the connection between HPV and oropharyngeal cancer and the frequency of dental visits compared to annual primary care visits, dental hygienists are uniquely positioned to help reduce the risk of HPV infection among their patients through vaccine education and promotion. The goal of this project is to evaluate the impact of a continuing education (CE) training on dental hygienists’ knowledge about HPV and the HPV vaccine. Methods This study used pre- and post-test survey design to collect data from dental hygienists. The CE training was presented at the Southwest Dental Conference on August 26th, 2022, in Dallas, Texas. Prior to the training, all attendees were asked to complete an online survey assessing their knowledge about HPV and the HPV vaccine. Knowledge questions included modes of transmission, types and sites of HPV-related cancers, and vaccine recommendations and indication. For example, "HPV is transmitted through skin-to-skin contact” was asked as a true or false question. With a total of 18 questions on the knowledge scale, participants were awarded 1 point per correct answer and no points for incorrect answers. Higher averages indicated higher knowledge, with 18 being the highest possible score. Following the 45-minute CE, participants completed a second online survey assessing their knowledge. Data were analyzed in SPSS using t-tests to assess for changes from pre-test to post-test. A p-value of <0.05 was considered statistically significant. Results While a total of 453 oral health providers were registered, only practicing dental hygienists (n=112) who had matched pre- and post-surveys were included in this analysis. Out of 18 items, the average number of correct responses pre-CE was 13.7 (SD=2.7), which was significantly higher following the CE (16.8 correct, SD=1.0; p<0.001). The item with the most significant knowledge increase pertained to the type of vaccine available for HPV (a virus-like particle vaccine, 39.1% pre-CE; 92.0% post-CE, p<0.001). Additional items with increases in knowledge included the various types of cancers directly linked to HPV such as anal cancer (54.9% pre-CE; 99.1% post-CE, p<0.001) and penile cancer (50.4% pre-CE; 97.3% post-CE, p<0.001). Conclusions The HPV vaccine is an FDA-approved form of cancer prevention, and the best predictor of HPV vaccination uptake is recommendation from a healthcare provider. The CE training resulted in increased knowledge regarding HPV-related cancers and the HPV vaccine, indicating a need for similar trainings that can help dental hygienists make stronger, more informed vaccination recommendations to their patients. Equipping dental hygienists with the most up-to-date knowledge, effective communication skills, and confidence to promote HPV vaccination among their patients could greatly reduce the number of missed clinical opportunities to recommend and refer for the HPV vaccine.Item Assessing Women's Knowledge of HPV and Willingness to Undergo At-Home HPV Self-Testing(2020) Thompson, Erika; Nazim, AsadPurpose: At-home self-testing for human papillomavirus (HPV) may be a strategy for increasing access to cervical cancer screening. This project aimed to examine the correlation between women's knowledge of HPV and willingness to self-test for HPV. Methods: An online survey (n=725) of women aged 30-65 who had not had a hysterectomy was conducted in June 2018. Survey items assessed HPV knowledge using 16 items (α=0.82) and willingness to undergo HPV self-testing. The participants were categorized into a willing or unwilling to self-test group according to their willingness score. Correct responses to the true/false HPV knowledge questions were used to create knowledge scores. Results: Most women (59.59%) were either very willing or somewhat willing to have at-home self-testing. The mean HPV knowledge of the willing group was 9.38 (out of 16), and the mean HPV knowledge of the unwilling group was 8.62, meaning the willing group was more knowledgeable. There was a significant association between HPV knowledge and willingness to self-test (p< 0.05). The largest differences in HPV knowledge between the willing and unwilling groups pertained to HPV characteristics, such as symptoms, modes of transmission, and risk factors. Conclusions: The results indicate that HPV knowledge and willingness to self-test are statistically associated. Knowledge of HPV may be a needed first-step in promoting HPV self-testing for cervical cancer screening in rural areas. Increasing HPV education efforts could increase the willingness to self-test and reduce the number of cervical cancer cases.Item Assessing Women’s Perceptions of Their HPV and Cervical Cancer Knowledge(2019-03-05) Matthes, Sarah; Thompson, Erika; O'Neal, MorganPurpose: This project aimed to assess women’s HPV and cervical cancer knowledge and women’s perceptions of their knowledge. With recent changes to cervical cancer screening guidelines in the US, it is an opportune time to assess women’s knowledge of cervical cancer and its primary cause, human papillomavirus (HPV). Women’s knowledge of HPV and cervical cancer may be beneficial for reducing anxiety and uncertainty with cervical cancer screening. Moreover, there is a need to examine if women’s perceptions of their knowledge align with knowledge levels, which may present opportunity for health education. Methods: An online survey (n=812) of women 30-65 years old without hysterectomy was conducted in June 2018. Survey items assessed knowledge of HPV (16-items), cervical cancer (12-items) and perceived ease of understanding cervical cancer screening information (Likert scale). Knowledge scores were created from correct responses to true/false questions. Descriptive frequencies for items and Kruskal-Wallis tests were used in SAS 9.4. Results: Most women (70%) perceived understanding cervical cancer screening information as easy or very easy. The mean HPV knowledge score was 8.10 (out of 16). The mean cervical cancer knowledge score was 6.88 (out of 12). Women’s perceptions of their understanding were significantly associated with HPV and cervical cancer screening knowledge (p Conclusion: Results indicate that women have an accurate perception of their cervical cancer screening knowledge. Additionally, the association between HPV and cervical cancer was noted by participants. Increasing knowledge of the high likelihood of HPV infection may increase screening willingness. Education that the clinical course of cervical cancer is slow and preventable may reduce testing anxiety. More public information on no and low cost screening resources may also help increase screening. These gaps represent patient and provider education opportunities that may assist in increasing adherence to cervical cancer screening recommendations.Item Association between Cyber-Bullying and Weapons Carrying at School: Analysis of the 2017 Youth Risk Behavior Survey(2019-03-05) Thompson, Erika; Morris, KimberlyObjective: Previous research has found that victims of bullying are more likely to carry a weapon and say that it is “not wrong” to take a gun to school. Moreover, studies have shown that cyberbullying and traditional bullying are highly correlated. With the rate of online harassment nearly doubling from 2000 to 2010 further research is needed to study the link between cyberbullying and weapons carrying. The objective of this study was to examine the association between cyberbullying and weapons carrying at school among adolescents participating in the 2017 Youth Risk Behavior Survey (YRBS). Methods: The YRBS 2017 is a representative dataset for 9th through 12th graders in both public and private schools in the United States (N = 14,765). The analytic sample was restricted to a complete case analysis for the variables of interest (N = 13,944). The outcome variable was weapon carrying on campus (yes/no). Predictor variables included: cyberbullying, sex, grade, race/ethnicity, and bullying. A survey-weighted adjusted logistic regression model was estimated for the association between cyberbullying and weapons carrying using SAS 9.4. Results: 14.84% of students surveyed reported experiencing cyberbullying and 3.51% reported ever carrying a weapon on school ground. Students reporting weapons carrying were 74.7% male, 32.8% 11th graders, and 56.0% white; 27.7% reported experience bullying, and 22.2% cyberbullying. In the multivariable model predicting the outcome of weapon carrying on school grounds, exposure to cyberbullying, (Adjusted Odds Ratio (AOR) = 1.70, 95% CI: 1.27, 2.29), being a male student (AOR = 3.60, 95% CI: 2.91, 4.44), being in 11th(AOR = 2.29, 95% CI: 1.64, 3.19) or 12th(AOR = 1.97, 95% CI: 1.27, 2.64) grade and being bullied on school grounds (AOR = 1.56, 95% CI:1.21, 2.00) were significantly associated. Conclusions: Although a statistically significant correlation between cyberbullying and carrying a weapon on school grounds was found, results should be interpreted with caution due to the temporality of the data, and correlation between bullying and carrying a weapon on school grounds. Regardless, the results show that additional research is needed to investigate the affect cyberbullying has on eventual weapons carrying to ensure schools remain safe in the modern era.Item Break a Sweat, Mend Your Mind: Exercise and Mood Among Adolescents(2019-03-05) Thompson, Erika; Harrison, SamanthaPurpose: The prevalence of depression in adolescents is rising, and regular exercise has been reported to have a decreasing effect on incidence of depressed mood in meta-analyses of adult interventions. There is a need to explore this association among adolescents. The purpose of this study was to examine the association between exercise and mood among United States adolescents responding to the Youth Risk Behavior Survey (YRBS) 2017. Methods: YRBS is a nationally representative sample of 9th through 12th grade students (N=14,765), and was restricted to an analytic sample (N=10,789). The outcome of interest was depressed or low mood (yes/no to feeling sad or hopeless in the past 12 months), and the exposure was physical activity (yes/no to being physically active for at least 60 minutes on five or more days in the past week). Covariates included: age, sex, race/ethnicity, physical education class attendance, sports team participation, and hours of sleep. SAS version 9.4 was used to perform survey-weighted descriptive estimates and crude and adjusted logistic regression models. Results: Overall, 47.5% of participants reported being physically active, and 31.3% reported feeling sad or hopeless in the last year. Respondents who reported physical activity were less likely to have reported feeling sad or hopeless when compared to those who were not physically active (OR=0.68, 95%CI 0.59, 0.79). When adjusting for age, sex, race/ethnicity, physical education class attendance, sports team participation, and hours of sleep, the association was no longer statistically significant (aOR=0.93 95%CI 0.80, 1.10). Conclusions: While an association between exercise and depressed mood was not observed in this cross-sectional study, further research is needed into the risk and protective factors for depression in adolescents due to the rising prevalence of the disorder.Item Cervical cancer screening: Does educational attainment moderate Protection Motivation Theory correlates?(2019-03-05) Garg, Ashvita; Matthes, Sarah; Thompson, Erika; Galvin, AnnalynnPurpose: Cervical cancer screening is recommended for women 21-65 years old. Disparities in cervical cancer screening exist by education attainment, yet no study to date has differentiated cervical cancer screening psychosocial predictors between women of varying education levels. This study assessed Protection Motivation Theory psychosocial factors (e.g., threat and coping appraisal) for cervical cancer screening adherence by educational attainment among U.S. women. Methods: Women, aged 30-65 years, without a hysterectomy, were surveyed online (n=812). The outcome was adherence (yes/no) to 2012 cervical cancer screening guidelines: 3-year pap testing or 5-year HPV co-testing. Threat and coping appraisal predictor variables were derived from the Protection Motivation Theory. Educational attainment was operationalized as high school or less (33%), some college (37%), and college graduate (30%). Using SAS 9.4, adjusted odds ratios estimated cervical cancer screening nonadherence, stratified by education. Results: Most women (71%) were adherent to screening recommendations: 68% of high school or less, 71% of some college, and 76% of college graduates. Salient predictors of screening nonadherence varied by educational attainment: lacking knowledge of community screening resources (aOR=3.05; 95%CI 1.44-6.45) for women with high school or less; perceiving screenings as painful (aOR=2.16; 95%CI 1.08-4.32) for women with some college; and uncertainty about cervical cancer curability (aOR=2.97; 95%CI 1.24-7.12) for women with college degrees. Conclusions: Designing interventions without factoring educational attainment may result in limited improvements to cervical cancer screening adherence. Accounting for education level can improve health-literate and population-specific initiatives seeking to address cervical cancer screening disparities.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 Contraceptive Method Use and Insurance Status among U.S. Women aged 15-49 years(2024-03-21) Brilleslyper, Emma; Akpan, Idara; Diener, Anelise; Thompson, ErikaPurpose: Healthy People 2030 set a goal to reduce unintended pregnancies to 36.5%, from the current baseline of 43%. Different methods of contraception have varying efficacy and effectiveness for pregnancy prevention. Insurance coverage is a key determinant for contraception access. This study aimed to investigate disparities in contraceptive method choice based on insurance status. Methods: This was a cross-sectional study of a nationally representative sample of women aged 15-49, using the 2017-2019 National Survey of Family Growth. Women not desiring pregnancy reported their insurance status and current method of contraception. Insurance status was operationalized as Private Insurance/Medi-Gap, Medicaid/CHIP, Medicare/other Government Insurance Plan, and Single-Service Plan. The outcome variable, current method of contraception, was operationalized into four categories: most effective methods (intrauterine devices (IUD), hormonal implant), moderately effective methods (pills, patch, ring, injectable), least effective methods (condoms, diaphragm, withdrawal, natural family planning, etc.)#_msocom_1, and no method of contraception. The association between insurance status and contraceptive method was assessed using multinomial logistic regression. Results: Among the participants, reported insurance statuses were private insurance/medi-gap (56.38%), Medicaid/CHIP/State sponsored (25.16%), Medicare/Military/Other government insurance (4.77%), and Single Service Plan/Indian Health Service/Uninsured (13.69%). For current contraception method, the women self-reported using most effective methods (27.20%), moderately effective methods (27.98%), least effective methods (30.76%), and no method (14.02%). Women insured through a single service plan, the Indian Health Service, or uninsured had lower odds of using most effective methods than no method of contraception (OR=0.32, 95%CI=0.13, 0.77), and lower odds of using the moderately effective methods (OR=0.21, 95%CI=0.07, 0.58), versus no method of contraception, compared to women with private insurance. Additionally, women with Medicaid/CHIP/state-sponsored health plan have lower odds of using the moderately effective methods (OR = 0.382, 95%CI=0.18, 0.84) versus no method of contraception, compared to women with private insurance. Conclusion: There were differences in contraceptive method choice based on insurance status. As all insurance plans are mandated to cover all FDA-approved methods of contraception, our study findings highlight the need to investigate further gaps in access, education, and freedom of choice. Future research should examine the causes underlying our findings and seek to identify potential strategies related to insurance status to improve access and reduce the risk of unintended pregnancy.Item Correlates of Cervical Cancer Screening Among U.S. Women: Findings from the National Health Interview Survey(2020) Thompson, Erika; Galvin, Annalyn; Garg, AshvitaPurpose: While cervical cancer rates have declined dramatically, the Healthy People 2020 goal for cervical cancer screening has not been reached. This study examined factors associated with up-to-date cervical cancer screening among women in the US. Methods: This study utilized data from the 2018 National Health Interview Survey (N=10,714 women, aged 21-70), with the main outcome as cervical cancer screening in the last 5 years (yes/no). Weighted logistic regression modeling estimated the association between cervical cancer screening and predictor variables. Results: Prevalence of up-to-date cervical cancer screening was 78.4%. Compared to White women, women from other races were less likely to receive a screening (aOR=0.71; 95%CI: 0.57, 0.88), and Black women were more likely (aOR=1.49; 95%CI: 1.19, 1.88). Hispanic women had higher odds of cervical cancer screening compared to non-Hispanics (aOR=1.58; 95% CI: 1.26, 1.99). Women between the ages of 20-29, who are divorced/widowed/separated or are not married, who have not talked to their healthcare providers recently, or who have not received HPV vaccination had lower odds of cervical cancer screening. Additionally, women who did not use the internet to search for health information (aOR=0.55; 95%CI: 0.48, 0.63) had lower odds of cervical cancer screening. Conclusion: Findings can inform targeted interventions to improve cervical cancer screening uptake and reduce cervical cancer mortality. Further studies should explore the barriers to cervical cancer screening among women who did not receive cervical cancer screening.Item Decrease in Mental Health Among Adolescent Students(2023) Jones, Courtni; Thompson, ErikaBackground: Persistent feelings of sadness or hopelessness has increased among adolescent high school students over time. Lack of physical activity has been identified as a risk factor for persistent feelings of sadness or hopelessness. The purpose of this study was to understand the epidemiology of persistent feelings of sadness or hopelessness and its association with physical activity among adolescents. Methods: Data from the Youth Risk Behavior Survey (YRBS), 2019, consisted of N=13,677. The main variable analyzed was 'felt sad or hopeless’(yes/no)and the association variable was 'were not physically active at least 60 minutes/day on all 7 days of the week’ (yes/no). Demographic variables measured: sex, race/ethnicity, grade, and sexual orientation. Statistical analysis used: logistic regression model, chi-squared test, and t-test using the YRBS data explorer tool. Results: The current (2019) prevalence of feelings of sadness or hopelessness among adolescents is 36.7%, an increase from previous years. Rates for feelings of sadness and hopelessness were highest among these demographic groups: Females (46.6%), Bisexuals (68.2%), 12th Graders (39%), American Indians (45%), Sex with both sexes (74.4%). There was a significant association between feelings of sadness or hopelessness among adolescents and students who were not physically active at least 60 minutes/day on all 7 days of the week, p-value=<0.01. Adolescent students that were not physically active at least 60 minutes per day on all 7 days of the week were more likely to experience feelings of sadness or hopelessness (39.2%), compared to adolescent students who were physically active at least 60 minutes per day on all 7 days of the week (29%). Conclusion: There were differences observed in sex, race/ethnicity, grade-level, and sexual orientation among students that experience feelings of sadness or hopelessness. Lack of physical activity is associated with feelings of sadness or hopelessness. Although the role of lack of physical activity cannot be determined in the causation of poor mental health among adolescent students, future research should focus on examining why there are large differences between different demographics and how to combat that issue to improve mental health. In addition, more research should focus on understanding the role physical activity plays in mental health, and specific solutions for how it can be used as a tool to improve mental health among adolescent students.Item E-cigarette Use Trend and Pattern among Texas High School Students: Considering the Inverse Relationship with Cigarette Smoking(2022) Odeyemi, Joseph; Thompson, ErikaPurpose: Over the last decade, e-cigarettes have grown in popularity, surpassing cigarettes as the most widely used tobacco product among adolescents in the United States. Current evidence suggests that using e-cigarettes (vaping) may be less harmful than smoking cigarettes; however, while the long-term effects of vaping are still being studied, it has been linked to chronic lung and cardiovascular diseases and an increased likelihood of transitioning to cigarettes. Despite the association between smoking and vaping, the upward trend of vaping among young people is infrequently studied in concert with the prevalence of cigarette smoking. The objectives of this study are to explore the prevalence of e-cigarette use and socio-demographic factors that influence this behavior, and to examine the trend of e-cigarette use and potential associations with cigarette smoking among Texas high school students. Methods: This study analyzed and presented data on the prevalence of current and frequent use of e-cigarette products and cigarette smoking among high school students from the 2019 Texas Youth Risk Behavior Survey (YRBS), a biennial cross-sectional survey with a sample size of 2032. Previous Texas YRBS data were referenced to report relevant trends. Analysis was conducted using the YRBS online interactive data tool which utilized SAS (version 9.4) and SUDAAN (version 11.0.1). The pairwise t-test and Wald chi-square tests were used to determine significant differences and associations between estimates. Results: Nearly one in five respondents (18.7%) reported e-cigarette use during the 30 days before the survey and a quarter of e-cigarette users reported vaping almost every day. Non-Hispanic White students were significantly more likely to report current use of e-cigarettes than Hispanic and non-Hispanic Black adolescents (P< 0.001). Students who identified as bisexual were also more likely to report vaping than students who identified as heterosexual (P=0.03). The likelihood of reporting electronic vapor product use also appeared to increase with high school grades. Overall, the prevalence of cigarette smoking appeared to be on the decline from a reported 17.4% in 2011 to 4.9% in 2019. On the contrary, e-cigarette use has been on the increase, achieving a peak prevalence of 18.7% in 2019. Conclusions: Current public health anti-tobacco strategies appear to be effective in reducing cigarette smoking but not vaping among adolescents. The popularity of e-cigarettes among high school students has increased steadily over the last 10 years; however, a remarkable decline was observed between 2015 and 2017. It is important to further investigate the causes of this reported decline as this may inform future public health strategies. Halting the upward trend of e-cigarette use is a priority as these products put adolescents at risk of significant morbidity.Item Examining Disparities in HPV Testing Knowledge among Women in the United States(2019-03-05) Galvin, Annalynn; Matthes, Sarah; Thompson, Erika; Garg, AshvitaPurpose: Human papillomavirus (HPV) is the cause of 99% of cervical cancers. In the US, HPV testing has recently been adopted as an option for cervical cancer screening in women over 30 years of age. Knowledge of HPV testing is important in influencing the acceptance of HPV testing among women. This study examined the association of sociodemographic covariates in relation to the knowledge of HPV testing among women in the United States. Methods: Women, ages 30 to 65 years, without hysterectomy, completed an online survey (N=812). The analytic sample was restricted to 507 women who were aware of HPV testing. The outcome, HPV testing knowledge, was calculated using a six-item validated scale. Sociodemographic covariates included: age, race, ethnicity, education level, income level, insurance status, relationship status, religious affiliation, and if previously had HPV vaccination. Multiple regression was used to identify variables that were uniquely associated with greater HPV testing knowledge using SAS 9.4. Results: The average age of women in the sample was 44 years, and there was a mean HPV testing knowledge score of 2.8 (out of 6). The multiple regression analysis revealed four independent correlates related to HPV testing knowledge. Lower knowledge was observed in older women compared to younger women (β = −.02, p = .01). Lower knowledge was also observed in women who did not have any health insurance (β = −.56, p = .02) or who did not know if they had ever received the HPV vaccination (β = −.83, p Conclusions: Findings from the study can be used to develop targeted prevention strategies and initiatives to improve HPV testing knowledge among women with HPV knowledge disparities. Improving HPV testing knowledge may promote uptake of this screening tool, and ultimately prevent cervical cancer morbidity and mortality.Item Examining Disparities in the Use of Electronic Vapor Products (EVPs) among the US Youths(2022) Dhakal, Smriti; Thompson, ErikaBackground: Electronic vapor products (EVPs) use is more common than cigarette smoking among US youths. EVPs may contain nicotine which is highly addictive, and the aerosol generated has carcinogens and toxic chemicals. Although public health efforts to reduce EVP use are in place, some demographic groups continue to experience a higher burden. In particular, sexual minorities are exposed to targeted marketing strategies and normative influence in social networks which puts them at increased risk. However, little is known about the prevalence of EVPs among sexual minority youths living in the US. This study aims to (1) identify sociodemographic characteristics associated with the use of EVP among US youths and (2) determine if EVP use disparities exist among sexual minorities. Methods: The 2019 Youth Risk Behavior Surveillance (YRBS) data for the entire US were used to assess demographic correlates of EVP use among high school students. The study sample was a nationally representative sample of students in grades 9-12 (n=13677). The CDC's YRBS data portal was used for analysis. T-test was used to identify statistical significance among variables and the level of significance was p< .05. Results: About 50.1% of US youths reported ever using EVPs. Non-Hispanic Black (p-value < .001), Hispanic/Latino (p-value < .001), and Asians (p-value < .001) were significantly less likely to ever use EVPs as compared to Non-Hispanic White students. More than half (56.0%) of students who identified as sexual minorities (gay/lesbian/bisexual students) reported ever using EVPs and sexual minorities were significantly more likely to have ever used EVPs as compared to heterosexual individuals (p-value < .001). Further, 71.4% of the students whose sexual contacts were same-sex only or both sexes reported ever using EVPs. Conclusion: The use of electronic vapor products is significantly high among Non-Hispanic White students and sexual minorities. This finding highlights the existence of disparities in EVP use and warrants the need for developing evidence-based strategies focusing on high-risk groups. Tailored efforts that can reach sexual minorities, combined with regulatory efforts from FDA, should be launched to reduce EVP use. Future research should focus on the factors influencing EVP use among sexual minorities such that specific areas could be targeted.Item Exploring the Association Between Patient-Centered Communication and Awareness of Human Papillomavirus Vaccine: A Cross-sectional Study(2024-03-21) Akpan, Idara; Nhpang, Roi San; Webb, Nathaniel; Alkhatib, Sarah; Krenek, Brittany; Griner, Stacey; Thompson, ErikaPurpose: Human papillomavirus (HPV) vaccination is effective in preventing anogenital and oropharyngeal cancers, including genital warts. The HPV vaccine is approved for individuals aged 9-45 years old and creates the opportunity for healthcare providers to educate parents, caregivers, and patients on the benefits of the vaccine. Effective provider-patient interactions promote collaboration, increase self-efficacy, and support decision-making. This study aimed to assess the association between patient-centered communication and patient awareness of the HPV vaccine. We also examined sociodemographic factors associated with HPV vaccine awareness. Methods: The sample population included adults aged 18-45 (n=1384) from the 2022 Health Information National Trends Survey (Cycle 6). The outcome variable was HPV vaccine awareness (yes/no), assessed by whether the respondent has ever heard of the cervical cancer vaccine or HPV shot. The primary predictor variable was patient-centered communication, and this was operationalized using the 7-item Patient-Centered Communication scale (PCC scale). The items assessed respondents’ experiences during their healthcare visits, such as the chance to ask questions, attention to their feelings, involvement in decision-making, time availability, clarity of information presented, comprehension of information, and help with uncertainty. The scale response options ranged from 1=Always to 4=Never. The association between patient-centered communication and HPV vaccine awareness was examined using weighted multivariable logistic regression, while controlling for age, sex, race, education attainment, marital status, health insurance status, and number of healthcare visits in the past 12 months. Results: The mean age of the sample population was 34.1 years (SD=7.2 years). Approximately 52.5% and 47.5% identified as women and men, respectively. Individuals identified as White non-Hispanic (56.2%), Black non-Hispanic (10.2%), Hispanic (19.6%), and Asian/Other non-Hispanic (14.0%). Approximately 40.4% of individuals had a college degree or higher, and 89.8% reported having health insurance coverage. Overall, 72.7% self-reported they had heard about the HPV vaccine. The PCC scale mean was 74.0 (range 0-100). Patient-centered communication was not statistically associated with HPV vaccine awareness. Compared to men, women had higher odds of HPV vaccine awareness (aOR=2.83; 95%CI=1.62-4.97). Individuals with some college (aOR=2.25; 95%CI=1.01-5.01) and college degree or higher (aOR=2.87; 95%CI=1.44-5.77) had higher odds of HPV vaccine awareness than those with less than a high school/12 years/high school diploma. Compared to individuals aged 18-26, individuals aged 27-45 had higher odds of HPV vaccine awareness (aOR=1.91; 95%CI=1.02-3.57). Black (aOR=0.24; 95%CI=0.12-0.49), Asian/Other (aOR=0.24; 95%CI=0.12-0.49), and Hispanic (aOR=0.36; 95%CI=0.21-0.59) individuals had lower odds of being aware of the HPV vaccine than whites. Conclusions: The absence of statistically significant relationship between patient-centered communication and HPV vaccine awareness underscores the need to investigate other factors that influence patient knowledge and decision-making regarding the HPV vaccine. Provider recommendation is one of the known strategies to address misconceptions and increase uptake of the HPV vaccine, particularly among populations who are at increased risk for HPV. However, individuals with limited or no access to healthcare may seek health information from other readily available sources. Exploring racial/ethnic disparities in HPV vaccine awareness is imperative, including identifying effective, evidence-based dissemination strategies that meet the information needs of diverse populations.Item Factors Influencing U.S. Women's Willingness for Utilizing Human Papillomavirus Self-Sampling(2021) Garg, Ashvita; Galvin, Annalynn; Griner, Stacey; Rosberger, Zeev; Daley, Ellen; Thompson, ErikaPurpose. HPV self-sampling is a novel method of HPV testing that is widely accepted in various countries. Recent modifications in the U.S. cervical cancer screening guidelines includes HPV testing and provides HPV self-sampling as another screening option, especially for underserved populations. Due to the scarcity of research regarding the process factors for HPV self-sampling, the current study examines the correlates of the willingness of women to have HPV self-sampling. Methods. A cross-sectional study was conducted among women between the ages of 30-65 years, with no history of hysterectomy (n=812). The outcome variable was a willingness to have HPV self-sampling test (yes/no). Predictor variables included various process factors. Adjusted logistic regression recognized correlates of HPV self-sampling willingness. Results. Higher odds of HPV self-sampling willingness were found among participants who preferred receiving self-sampling information from healthcare providers (OR=2.64; 95%CI 1.54, 4.52) or media (OR=2.30; 95%CI 1.51, 3.48). However, lower odds of self-sampling willingness were found among participants who did not want to pay for the self-sampling kit (OR=0.21; 95%CI 0.14, 0.32) or were not sure which method they preferred for receiving the kit (OR=0.15, 95%CI 0.07, 0.31) as compared to those preferred the mail. Conclusions. Prior to implementing any HPV self-sampling program, it is essential to understand women's preferences for process factors for this screening method for a successful implementation. Strengthening the infrastructural supports can help ensure improved and equitable access to this convenient and private screening method.