Kyl Myers

Understanding Religious Variations in Sexuality and Sexual Health

In this chapter, we provide an overview and critical examination of published research concerning the impact of religious involvement on the outcomes of sexuality and sexual health across the life course. We take a broad approach, focusing on a variety of important topics, including sexual behavior, sexual health education, abortion attitudes and behavior, HIV/AIDS, attitudes toward gays and lesbians, and the lived experiences of sexual minorities. In the future, researchers should (1) employ more comprehensive measures of religious involvement, (2) investigate understudied outcomes related to sexuality and sexual health, (3) explore mechanisms linking religion, sexuality, and sexual health, (4) establish subgroup variations in the impact of religious involvement, and (5) formally test alternative explanations like personality selection and social desirability. Research along these lines would certainly contribute to a more comprehensive understanding of religious variations in sexuality and sexual health across the life course.

Intimate Partner Violence, Childhood Abuse, and In-Law Abuse Among Women Utilizing Community Health Services in Gujarat, India

Previous studies in India suggest high prevalence of intimate partner violence (IPV), childhood abuse, and abuse from in-laws. Yet few studies examined IPV, childhood abuse, and abuse from in-laws together. The purpose of this study is to examine the association between IPV, childhood abuse, and abuse from in-laws, and types of abuse (physical, sexual, and emotional abuse) among women utilizing community health services for the economically disadvantaged in India. This study contributes to expanding the literature on abuse experience and providing knowledge for developing intervention programs and research projects to improve health and safety of economically disadvantaged women. The data were collected from women aged 18 years old or older at 18 community health centers that are primarily for the economically disadvantaged in Gujarat, India, in October and November 2013. Of the 219 women who completed a self-administered survey, 167 participants, who had ever been married and indicated whether they had been abused by their spouse or not, were included in analysis. More than 60% of the participants experienced IPV, childhood abuse, and/or abuse from in-laws, often with multiple types of abuse. Physical abuse is a major issue for IPV, childhood abuse, and in-law abuse. Emotional abuse potentially happens along with physical and/or sexual abuse. Abuse from in-laws requires greater attention because all types of abuse from in-laws were associated with IPV. Community health centers should provide abuse prevention and intervention programs that have involvement of family members as well as women who are at risk of being abused.

Contraceptive method use during the community-wide HER salt lake contraceptive initiative

Objectives To describe a community-wide contraception initiative and assess changes in method use when cost and access barriers are removed in an environment with client-centered counseling. Methods HER Salt Lake is a prospective cohort study occurring during three 6-month periods (September 2015 through March 2017) and nested in a quasiexperimental observational study. The sample was women aged 16 to 45 years receiving new contraceptive services at health centers in Salt Lake County, Utah. Following the control period, intervention 1 removed cost and ensured staffing and pharmacy stocking; intervention 2 introduced targeted electronic outreach. We used logistic regression and interrupted time series regression analyses to assess impact. Results New contraceptive services were provided to 4107 clients in the control period, 3995 in intervention 1, and 3407 in intervention 2. The odds of getting an intrauterine device or implant increased 1.6 times (95% confidence interval [CI] = 1.5, 1.6) during intervention 1 and 2.5 times (95% CI = 2.2, 2.8) during intervention 2, relative to the control period. Time series analysis demonstrated that participating health centers placed an additional 59 intrauterine devices and implants on average per month (95% CI = 13, 105) after intervention 1. Conclusions Removing client cost and increasing clinic capacity was associated with shifts in contraceptive method mix in an environment with client-centered counseling; targeted electronic outreach further augmented these results.

Student-led health education programmes in the waiting room of a free clinic for uninsured patients:

Objective: Free clinics provide free or reduced fee healthcare to individuals who lack access to primary care and are socio-economically disadvantaged in the USA. Free clinic patients may have health education needs, but experience barriers to attending health education programmes. In an attempt to reach out to free clinic patients who might not otherwise attend health education classes, this project examined the efficacy of student-led health education classes conducted in the waiting room prior to a patient’s appointment with a provider. Design: The classes had two areas of focus: women’s health and health information. Health educators and Spanish interpreters were graduate and undergraduate students. Setting: This study was conducted in the waiting room of a free clinic in the Intermountain West region of the USA. Method: The health education classes were held 22 times in total from late August to early December 2014. Results: While the survey-based assessment of the programme did not show a difference in levels of health consciousness, health information seeking and health attitudes, the programme potentially increased interest in attending the health education classes. Conclusion: There were some challenges associated with the implementation of a health education class in the waiting room setting, particularly in regards to environments, evaluation and interpretation services. Future projects are needed to address challenges associated with conducting a health education class in a waiting room setting. In addition, a variety of health topics, evidence-based evaluation and interpreter services are key for future success.

Health Status and Social Characteristics Among the Uninsured Using a Mental Health Free Clinic.

Free clinics provide free or reduced fee primary care services to the underor uninsured and play an important role in serving socio-economically disadvantaged community members, who otherwise do not have access to healthcare. Since the first free clinic started in 1967, the number of free clinics in the USA has increased to approximately 1200. Previous studies found that mental health is one of the main problems among primary care free clinic patients. More than 12% of primary care free clinic visits were for mental and behavioral disorders. In a study of one free clinic, patients reported being moderately depressed and had lower mental health functioning compared to the US general population and depression was associated with poor health-related quality of life. 6 On-site mental healthcare services at a free clinic or a community health clinic provide mental healthcare to the unor under-insured. In general, providing mental health services as a part of primary care improves access to mental healthcare,; however, a national survey shows that only 30% of free clinics provide on-site mental health services. Primary care free clinics that are unable to provide on-site mental health services need to find referral clinics for the mental healthcare needs of their patients. Mental health free clinics, which exclusively provide mental health services to the unor under-insured, may be an option for free clinic patients. The purpose of this study is to describe the health status and social characteristics of the uninsured utilizing a mental health free clinic. To the best of our knowledge, this is one of the first

One in three: challenging heteronormative assumptions in family planning health centers

OBJECTIVES To estimate the prevalence of sexual-minority women among clients in family planning centers and explore differences in LARC uptake by both sexual identity (i.e., exclusively heterosexual, mostly heterosexual, bisexual, lesbian) and sexual behavior in the past 12 months (i.e., only male partners, both male and female partners, only female partners, no partners) among those enrolled in the survey arm of the HER Salt Lake Contraceptive Initiative. METHODS This survey categorized participants into groups based on reports of sexual identity and sexual behavior. We report contraceptive uptake by these factors, and we used logistic and multinomial logistic models to assess differences in contraceptive method selection by sexual identity and behavior. RESULTS Among 3901 survey respondents, 32% (n=1230) identified with a sexual-minority identity and 6% had had a female partner in the past 12 months. By identity, bisexual and mostly heterosexual women selected an IUD or implant more frequently than exclusively heterosexual women and demonstrated a preference for the copper T380 IUD. Exclusively heterosexual and lesbian women did not differ in their contraceptive method selection, however, by behavior, women with only female partners selected IUDs or implants less frequently than those with only male partners. CONCLUSION One in three women attending family planning centers for contraception identified as a sexual minority. Sexual-minority women selected IUDs or implants more frequently than exclusively heterosexual women. IMPLICATIONS Providers should avoid care assumptions based upon sexual identity. Sexual-minority women should be offered all methods of contraception and be provided with inclusive contraceptive counseling conversations.