Samantha Carlson

Determining menstrual phase in human biobehavioral research: A review with recommendations.

Given the volume and importance of research focusing on menstrual phase, a review of the strategies being used to identify menstrual phase and recommendations that will promote methodological uniformity in the field is needed. We conducted a literature review via Ovid Medline and PsycINFO. Our goal was to review methods used to identify menstrual phase and subphases in biobehavioral research studies with women who had physiologically natural menstrual cycles. Therefore, we excluded articles that focused on any of the following: use of exogenous hormones, the postpartum period, menstrual-related problems (e.g., polycystic ovarian syndrome, endometriosis), and infertility/anovulation. We also excluded articles on either younger (<18 years old) or older (>45 years old) study samples. We initially identified a total of 1,809 articles. After our exclusionary criteria were applied, 146 articles remained, within which our review identified 6 different methods used to identify menstrual phase and subphases. The most common method used was self-report of onset of menses (145/146 articles) followed by urine luteinizing hormone testing (50/146 articles) and measurement of hormones (estradiol and/or progesterone) in blood samples (49/146 articles). Overall, we found a lack of consistency in the methodology used to determine menstrual phase and subphases. We provide several options to improve accuracy of phase identification, as well as to minimize costs and burden. Adoption of these recommendations will decrease misclassification within individual studies, facilitate cross-study comparisons, and enhance the reproducibility of results.

Use of hormonal contraceptives and smoking cessation: A preliminary report

Although endogenous sex hormones influence smoking-related outcomes, little is known about the effect of exogenous sex hormones. Therefore, the goal of this preliminary study was to examine differences in withdrawal symptoms and cessation between women using hormonal contraceptives (HC), women not using hormonal contraceptives (no-HC) and men. Utilizing data from two recently completed smoking cessation randomized clinical trials, we selected participants who were between the ages of 18-35years old. Participants were classified based on use of hormonal contraceptives and gender, then matched based on pharmacotherapy randomization assignment and baseline cigarettes per day. Participants provided self-reported assessments on withdrawal, craving and negative affect, and smoking status was assessed for 52weeks after quit date. Participants (N=130) were 28.7±0.4years old and smoked 16.8±0.6 cigarettes/day. Compared to both no-HC and men, the HC group had significantly greater withdrawal one week prior to the quit date, on the quit date and one week after the quit date. During the first week of attempted abstinence, craving declined in HC and in men, but increased in no-HC. At end of treatment, the HC group was at 3.73 times higher odds of being abstinent compared to men (95% confidence interval: 1.12-12.40). There were no group differences in abstinence rates at Week 26 or 52. These data suggest that HC users may experience more adverse levels of withdrawal, though may be more likely to achieve short-term abstinence. Future research is needed to replicate our observations and explore mechanisms of action.

Mental health, relationships, and sex: exploring patterns among bisexual individuals in mixed orientation relationships

ABSTRACT Drawing on minority stress theory and sexual health literature, this exploratory study tested the relations of bisexual identity factors (e.g. anticipated binegativity, identity affirmation), minority stressors (e.g. isolation and vicarious trauma), and sexual and relationship variables (e.g. sexual functioning, relationship satisfaction) with mental health. Participants were 53 self-identified bisexual individuals in a mixed orientation relationship (MORE) with partners who did not also identify as bisexual. Moderate or above levels of depression, anxiety, and stress were reported by 34.5%, 25.4%, and 27.3% of the sample, respectively. Minority stressors were examined as mediators of the relations of bisexual identity factors and mental health outcomes. Isolation significantly mediated anticipated binegativity and depression, anxiety, and stress. Additionally, vicarious trauma mediated the relation of bisexual identity affirmation with anxiety. Consistent with existing literature, mental health concerns were negatively correlated with various aspects of sexual functioning and relationship satisfaction. Bisexual individuals in monogamous relationships with lesbian-identified partners reported lower stress levels than those with heterosexual partners. Results from the current study provide preliminary information about the health of bisexual individuals in MOREs, and point to minority stressors as potentially fruitful targets of prevention and intervention efforts to reduce negative mental health outcomes among bisexual populations.

Postpartum Changes in Mood and Smoking-Related Symptomatology: An Ecological Momentary Assessment Investigation

IntroductionnPostpartum smoking relapse is a highly prevalent public health problem. Mood and breast feeding are significantly associated with smoking relapse, although less is known about the temporality of these relationships. Therefore, this study utilized ecological momentary assessments (EMA) to prospectively examine changes in mood and smoking-related symptomatology in relationship to three events-childbirth, termination of breast feeding, and smoking relapse. We expected all three events to significantly alter mood and smoking-related symptomatology.nnnMethodsnWe enrolled a sample of pregnant women who had recently quit smoking and intended to remain quit during the postpartum. Participants were randomized to active/placebo progesterone to prevent postpartum relapse. Participants also completed daily EMA to collect data mood and smoking-related symptomatology as well as our three events of interest.nnnResultsnParticipants (n = 46) were, on average, 26.5 ± 0.8 years old and, prior to pregnancy, smoked 10.1 ± 0.7 cigarettes/day. We noted a number of significant within- and between-subject relationships. For example, participants reported a 24% decline in negative affect after childbirth (p = .0016). Among those who relapsed to smoking (n = 23), participants randomized to placebo had a significant increase in cigarette craving after relapse (β = 1.06, 95% confidence interval [CI] = 0.62 to 1.49, p value = .0003), whereas participants randomized to active progesterone did not (β = 0.63, 95% CI = -0.35 to 1.62, p value = .1824).nnnConclusionsnThese observations suggest that mood and smoking-related symptomatology are influenced by childbirth, breast feeding, smoking relapse, and use of exogenous progesterone. Future research should explore how these observations may inform novel postpartum smoking relapse-prevention interventions.nnnImplicationsnPostpartum smoking relapse has been a persistent public health problem for more than 40 years. Although a number of significant predictors of postpartum smoking relapse have been identified (eg, depression and breast feeding), much of these analyses have relied on cross-sectional and/or self-reported retrospective data. Therefore, for the first time, we utilized ecological momentary assessment to explore the effect of childbirth, termination of breast feeding, and smoking relapse on mood and smoking-related symptomatology (eg, craving). Numerous significant relationships were observed, including a 96% increase in craving after smoking relapse. These novel observations can inform new and effective postpartum smoking relapse-prevention programs.

Patient perspectives on loss of local obstetrical services in rural northern Minnesota

BACKGROUNDnObstetrical care has been declining in rural communities. We examined patient choices and perspectives from two rural northern Minnesota communities who lost their local obstetrical services in July 2015. Our purpose was to characterize obstetrical use patterns through the years leading to and following the closure and to explore the effects of the closure on these communities.nnnMETHODSnInformation introducing the project and providing access to the survey was mailed to women who received prenatal care in the communities of interest. Responses were analyzed quantitatively and qualitatively.nnnFINDINGSnTwo hundred and one participants completed the survey with 356 deliveries reported from 1990 to 2016. Before the closure, there was a trend toward an increasing percentage of women electing regional delivery (Pxa0<xa0.001); however, women were still 1.6 times more likely to choose local (62%) than regional (38%) delivery. Reasons for choosing delivery location changed over the decades. While birth experiences remained positive or extremely positive, anxiety about getting to the hospital rose 10-fold from 1990 to 2016 (5%-51%, Pxa0<xa0.001). Women voiced substantial concern about the lack of local obstetrical services. Qualitative analysis revealed significant negative emotional reactions and concerns for the consequences of this loss for the viability of their rural communities.nnnCONCLUSIONSnChoices and opinions about obstetric care have significantly changed from 1990 to 2016 in rural Minnesota. Understanding these changes can help address shifting risks and costs to rural communities here and elsewhere in an effort to support and sustain healthy, viable rural communities.

Barriers to Quitting Smoking Among Young Adults: The Role of Socioeconomic Status

Purpose: The aims of this analysis were to explore how self-reported barriers to quitting vary by socioeconomic status (SES) among young-adult smokers and to assess their relationship to quitting. Design: This analysis uses 2 waves of telephone-survey data from the Minnesota Adolescent Community Cohort study. Setting: Midwestern United States. Participants: Participants (n = 419) were smokers aged 17 to 24 years. Measures: Socioeconomic status was estimated using the highest level of education completed by the participants’ parents. Demographics, smoking behavior, and perceived barriers to quitting were collected via survey questions. Analysis: Differences in barriers by SES were assessed using prevalence ratios (PRs). Relative risks were calculated to assess the association between barriers and quitting status 1 year later, testing for effect modification by SES. Results: Compared to the high SES group (n = 314), the low SES group (n = 105) was more likely to report several barriers to quitting; however, only the risk of gaining weight was significantly more common (PR: 1.38 [1.05-1.83]). There were no significant associations between barriers and quitting status 1 year later, but the number of cigarettes per day was consistently related to the likelihood of quitting 1 year later, regardless of SES. Conclusion: Despite the limited generalizability to racially diverse populations and different geographic locations, the results suggest perceived barriers may not differ by SES or predict quitting among young adults; however, nicotine dependence may play an important role.

Examining characteristics associated with quitting smoking during pregnancy and relapse postpartum

INTRODUCTIONnSmoking during pregnancy is a significant public health concern that can cause adverse health outcomes for both the mother and fetus. Studies have shown only 40% of women quit smoking during pregnancy, with more than half relapsing within 6months, and up to 90% relapsing within one year. This study investigates differences in demographics and smoking-related symptomatology between pregnant smokers and pregnant quitters, as well as factors associated with postpartum relapse.nnnMETHODSnData on pregnant smokers and pregnant quitters were obtained from two separate parent studies. Data on smoking demographics and smoking-related symptomatology were collected at screening visits.nnnRESULTSnCompared to pregnant smokers, pregnant quitters had more favorable smoking characteristics (e.g., smoked fewer cigarettes per day, reported higher motivation for abstinence and less dependency). They also had more favorable relationship characteristics (e.g., were more likely to be married, less likely to have a significant other who smokes) and had less reproductive liability (e.g., fewer pregnancies, fewer children). In terms of symptomatology, pregnant quitters reported more positive affect, negative affect, physical symptoms and withdrawal but less craving. Predictors of postpartum relapse included increased maternal age, having a significant other who smokes and an increased likelihood of returning to smoking after pregnancy (self-reported prior to delivery).nnnCONCLUSIONSnSeveral demographics and smoking-related symptomatology were significantly different between pregnant quitters and pregnant smokers. In addition, multiple factors predicting postpartum relapse were identified. This information can inform personalized interventions for high risk pregnant smokers and pregnant quitters at risk for postpartum relapse.

Effect of brief exercise on urges to smoke in men and women smokers

INTRODUCTIONnAlthough smoking urges have been demonstrated to vary by gender and also be influenced by exercise, it is unknown if exercise has a differential effect on smoking urges by gender. This study aimed to explore gender-specific effects of an acute bout of exercise on cessation-related symptoms in men and women smokers during acute abstinence.nnnMETHODSnWe enrolled smokers (≥5 cigarettes/day) who were 18-40years old for a study on exercise and smoking behavior. Participants abstained from smoking for at least 3h, prior to measurement of their maximal oxygen consumption tested, which was the acute bout of exercise. Prior to and after the exercise, participants completed the Questionnaire of Smoking Urges - Brief and the Minnesota Nicotine Withdrawal Scale.nnnRESULTSnParticipants (n=38; 61% women) were, on average, 30.0±0.9years old and smoked 13.0±0.8 cigarettes/day. All measured aspects of cessation-related symptoms significantly improved after the exercise in both men and women. In women there was a significant decline in anticipated relief from negative affect after the exercise (women: -0.45±0.20, p=0.0322; men: -0.41±0.26, p=0.1312). In men there was a significant decline in the intention to smoke after the exercise (men: -0.77±0.23, p=0.0053; women: -0.66±0.37, p=0.0909).nnnCONCLUSIONSnAn acute bout of exercise reduced smoking urges in both men and women smokers during an acute state of abstinence. Additional research is needed to replicate these observations in a larger, more diverse sample, and to explore the implication of these observations on cessation.

Differences in mood and cortisol by menstrual phase during acute smoking abstinence: A within-subject comparison

There is evidence that smoking-cessation success differs by menstrual phase and sex hormone levels; however, the biological mechanisms underlying these differences are not clear. One possibility is that variation in cortisol throughout the menstrual cycle and early smoking abstinence may be partly responsible. The goal of this secondary-data analysis was to conduct a within-subject examination of the effects of menstrual phase and smoking abstinence on salivary cortisol and mood. Data are from a controlled crossover trial, in which participants completed 2 testing weeks during their follicular and luteal phases. During each testing week, they smoked ad libitum during the first 2 days and then abstained from smoking during the next 4 days. Salivary cortisol and self-reported mood were collected 5 times on the day before abstinence (D0) and the first (D1) and third (D3) days of abstinence. Participants (n = 125) were, on average (mean ± SE), 29.4 ± 0.6 years old and smoked 12.6 ± 0.5 cigarettes/day. Whereas salivary cortisol varied significantly by time of day (p < .0001) and smoking abstinence (D0 to D1: &bgr; = −0.06 ± 0.02 log[ng/ml], p = .0074 and D3: &bgr; = −0.05 ± 0.02 log[ng/ml], p = .0117). no significant differences by menstrual phase were observed. Craving increased from D0 to D1 during the follicular phase but decreased in the luteal phase (+0.31 vs. −0.15, &bgr; = 0.46 ± 0.19, p = .0162). This work builds on prior observations in demonstrating a decrease in cortisol in acute smoking abstinence and menstrual phase differences in craving. The results provide further evidence that cortisol levels do not vary by menstrual phase in the first few days of abstinence.

Sexual Health Knowledge of U.S. Medical Students: A National Survey

BACKGROUNDnSexual health is a critical component of overall wellness; however, only half of U.S. medical schools currently require formal instruction in sexuality.nnnAIMnThis study sought to quantify the sexual health knowledge of undergraduate medical students using a novel survey tool evaluating 6 domains: sexual function and dysfunction; fertility and reproduction; sexuality across the lifespan; sexual minority health; society, culture, and behavior; as well as safety and prevention.nnnMETHODSnA novel 32-question survey tool was developed by subject matter experts from the University ofxa0Minnesota Program in Human Sexuality. Survey questions were derived from the 2012 and 2014xa0Summitsxa0on Medical School Education in Sexual Health as well as the Sexuality Information and Education Council of the United States Guidelines for Kindergarten through 12th Grade. The total knowledge score was calculated out of 30 points (excluding 2 terminology questions that were subjective). Medical students at 178 allopathic and osteopathic medical schools in the United States were invited to take the online survey.nnnOUTCOMESnStudents performed below a passing rate (70%) in 4 of the 6 knowledge categories and below a passing rate overall in the knowledge assessment.nnnRESULTSnSurvey respondents (nxa0= 1,014) scored an average of 66% correct (approximately 20/30). Overall, students scored lowest on questions regarding safety and prevention (x- = 49%) and highest on questions regarding sexuality across the lifespan (x- = 75%). Higher knowledge scores were associated with the following variables (P < .05): medical school year, race/ethnicity, sexual orientation, religious affiliation, future medical specialty choice, program type (MD/DO), and taking a human sexuality course in medical school.nnnCLINICAL IMPLICATIONSnMedical students may be under-prepared to address essential sexual health issues in future clinical practice.nnnSTRENGTHS & LIMITATIONSnTo the knowledge of the authors this is the only contemporary study seeking to measure U.S. medical student sexual health knowledge. Limitations include sample population size and diversity as well as a non-validated survey tool.nnnCONCLUSIONnSignificant advances must be made in undergraduate medical education in order to prepare future physicians to address critical issues such as sexually transmitted disease, family planning, and health disparities. Warner C, Carlson S, Crichlow R, etxa0al. Sexual Health Knowledge of U.S. Medical Students: A National Survey. J Sex Med 2018;15:1093-1102.