To examine the racial, ethnic and cultural differences in postpartum participation of women who participated in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) during pregnancy by completing a retrospective analysis of observational data on 35,903 women who enrolled in Minnesota WIC during pregnancy, from April 2018 to March 2020. Descriptive analyses were completed using chi-square tests of association to show differences in postpartum WIC participation by maternal demographics and health risk codes of the WIC participants. Binary logistic regression and multivariate logistic regression were used to obtain odds ratios to compare the likelihood of postpartum WIC participation across different races, ethnicities and cultural groups. Asian/Pacific Islander, East African, Hispanic, Hmong, Multigenerational Black, and Other Black pregnant participants were more likely than White participants to return to WIC postpartum (adjusted odds ratio (AOR) 2.54, 95% confidence interval (CI) 1.87–3.46; AOR 3.35, 95% CI 2.40–4.66; 1.30, 95% CI 1.10–1.54; AOR 6.76, 95% CI 4.39–10.42; AOR 1.40, 95% CI 1.11–1.77, AOR 1.52, 95% CI 1.26–1.83, respectively). American Indian pregnant participants were less likely than White participants to return to WIC postpartum (AOR 0.70, 95% CI 0.54–0.92). These findings can help the Minnesota WIC program, as well as other WIC programs, better understand which cultural groups may need more specific outreach strategies to keep women participating in the program after giving birth. Further research is needed to understand why postpartum women choose to participate, or choose not to participate, in WIC. It is already known that culture, race and ethnicity influence the likelihood of WIC program participation. Research also has shown that WIC participation can have positive impacts on the health of women, infants and children. This research adds depth to previous findings on prenatal WIC participation by describing the differences in postpartum WIC participation by race, ethnicity and cultural group. This research can be used for outreach planning within the WIC program.

Helicopter parenting, a parenting style defined by over-involvement, may lead to poor health outcomes. However, research has primarily focused on children and adolescents from White, high socio-eco...

This paper summarizes the current research on the impact of abstinence-only sex education programs on LGBTQ+ adolescent health in the USA. We also seek to explore the current barriers to implementing comprehensive sex education, as well as discuss the future of LGBTQ+ adolescent health by outlining crucial components of LGBTQ+-inclusive sex education. The US sex education debate is centered on two approaches: abstinence-only and comprehensive. Abstinence-only sex education emphasizes risk reduction through abstaining from sexual behavior and has been found to be ineffective in promoting healthy sexual behavior among adolescents, compared to comprehensive sex education which centers on disseminating inclusive and medically accurate information. Abstinence-only sex education is taught through a heteronormative framework that excludes and devalues the experiences of LGBTQ+ adolescents. LGBTQ+ individuals are at increased risk for negative health outcomes as compared to their cisgender heterosexual counterparts. Lack of knowledge regarding safe sexual practices and consent, coupled with the shame and fear-based messaging promoted by abstinence-only sex education, further contributes to the health disparities experienced by LGBTQ+ youth. The content and inclusivity of sex education has important implications for the health of LGBTQ+ youth. Abstinence-only sex education further compounds the health disparities experienced by LGBTQ+ adolescents by erasing LGBTQ+ representation and leaving out crucial information on diverse, non-heterosexual sex practices. Numerous barriers exist to implementing comprehensive, inclusive sex education including funding, policies, teacher training, and attitudes toward sex and LGBTQ+ individuals. To address these health disparities, we must listen to and amplify the voices of LGBTQ+ youth to promote safe, comprehensive, and LGBTQ+-inclusive content within our sex education system in the USA.

<p>Understanding social determinants that shape pertinent developmental shifts during emerging adulthood (i.e., those aged 18-25) and their associations with psychological health requires a nuanced approach. In our exploratory study, we investigated how multiple social identities and lived experiences generated by systems of marginalization and power (e.g., racism, classism, sexism) intersect in connection to the mental-emotional well-being of emerging adults (EAs). EAT-2018 (Eating and Activity over Time) data were collected from 1,568 EAs (mean age = 22.2±2.0 years) recruited initially in 2010 from Minneapolis/St Paul schools. Conditional inference tree (CIT) analyses were employed to treat ‘social location’ and systems of marginalization and power as interdependent social factors influencing EAs’ mental-emotional well-being outcomes: depressive symptoms, stress, self-esteem, and self-compassion. CITs identified EAs subgroups with differing mean levels of mental-emotional well-being outcomes, distinguished primarily by marginalized social experiences (e.g., discrimination, financial difficulties) rather than social identities themselves. The relative positioning of EAs’ experiences of social marginalization (e.g., discrimination) to their social identities (e.g., race/ethnicity) suggests the social experiences generated by systems of privilege and oppression (e.g., racism) are more adjacent social determinants of mental-emotional well-being than the social identities used in public health research to proxy the oppressive systems that give them social meaning.</p>

Objective: To determine individual- and country-level factors associated with self-reported changes in solo and partnered sexual behaviors in an international sample of adults during COVID-19. Methods: Data were from the International Sexual Health And REproductive Health during COVID-19 study (I-SHARE)—a cross-sectional, multi-country study (N = 26 countries) assessing adult (N = 19,654) sexual/reproductive health before and during the first wave of COVID-19. We examined self-reported changes (three-point scale: decreased, no change, increased) in solo masturbation, hugging/holding hands/cuddling with a partner, sex with a primary partner, sex with a casual partner, sexting with a partner, viewing sexually explicit media and partnered cybersex. Ordinal regression assessed the impact of individual (age, gender- and sexual-identity, romantic partnership status, employment and income stability, household change and content, mental well-being, changes in alcohol use, and changes in marijuana use) and country-level (e.g., Oxford Stringency Index, Human Development Index, and the Palma Ratio) factors on behavior change. Results: The most common behavior to increase was hugging, kissing, or cuddling with a partner (21.5%), and the most common behavior to decrease was sex with a main partner (36.7%). Household factors like job/income instability and having children over the age of 12 years were significantly associated with decreased affectionate and sexual partnered sexual behaviors; more frequent substance use was linked to significantly increased solo, partnered, and virtual sexual behaviors. Conclusions: Understanding changes in sexual behaviors—as well as the factors that make changes more or less likely among adults around the world—are important to ensure adequate sexual health support development for future public health emergencies.

Background Low: syphilis testing uptake is a major public health issue among : men who have sex with men (MSM) in many low- and middle-income countries. Syphilis self-testing (SST) may complement and extend facility-based testing. We aimed to evaluate the effectiveness and costs of providing SST on increasing syphilis testing uptake among MSM in China. Methods and findings An open-label, parallel 3-arm randomized controlled trial (RCT) was conducted between January 7, 2020 and July 17, 2020. Men who were at least 18 years of age, had condomless anal sex with men in the past year, reported not testing for syphilis in the last 6 months, and had a stable residence with mailing addresses were recruited from 124 cities in 26 Chinese provinces. Using block randomization with blocks of size 12, enrolled participants were randomly assigned (1:1:1) into 3 arms: standard of care arm, standard SST arm, and lottery incentivized SST arm (1 in 10 chance to win U S$15: if they had a syphilis test). The primary outcome was the proportion of participants who tested for syphilis during the trial period and confirmed with photo verification and between arm comparisons were estimated with risk differences (RDs). Analyses were performed on a modified intention-to-treat basis: Participants were included in the complete case analysis if they had initiated at least 1 follow-up survey. The Syphilis/HIV Duo rapid test kit was used. A total of 451 men were enrolled. In total, 136 (90·7%, 136/150) in the standard of care arm, 142 (94·0%, 142/151) in the standard of SST arm, and 137 (91·3%, 137/150) in the lottery incentivized SST arm were included in the final analysis. The proportion of men who had at least 1 syphilis test during the trial period was 63.4% (95% confidence interval [CI]: 55.5% to 71.3%, p = 0.001) in the standard SST arm, 65.7% (95% CI: 57.7% to 73.6%, p = 0.0002) in the lottery incentivized SST arm, and 14.7% (95% CI: 8.8% to 20.7%, p < 0.001) in the standard of care arm. The estimated RD between the standard SST and standard of care arm was 48.7% (95% CI: 37.8% to 58.4%, p < 0.001). The majority (78.5%, 95% : CI: 72.7% to 84.4%, p < 0.001) of syphilis self-testers reported never testing for syphilis. The cost per person tested was US $26.55 for standard SST, US$28.09 for the lottery incentivized SST, and US$66.19 for the standard of care. No study-related adverse events were reported during the study duration. Limitation was that the impact of the Coronavirus Disease 2019 (COVID-19) restrictions may have accentuated demand for decentralized testing.

Objective: Digital technology use and muscle-building behaviors reflect a wide range of behaviors with associated health risks. However, links between digital technology use and muscle-building behaviors remain unknown and this study aimed to address this gap. Method: Data were collected from a diverse sample of 1,483 young adults (mean age 22.2 ± 2.0 years) participating in the population-based Eating and Activity over Time 2018 study. Gender-stratified-modified Poisson regression models were used to determine cross-sectional associations between three types of digital technology use (screen time, social media, weight-related self-monitoring apps) and five types of muscle-building behaviors (changing eating, exercise, protein powders/shakes, pre-workout drinks, steroids/growth hormone/creatine/amino acids) in young adulthood, adjusted for sociodemographic characteristics and body mass index. Results: Screen time and social media were either not found to be associated with muscle-building behaviors or in a few instances, associated with less use of these behaviors (e.g., screen time and pre-workout drinks in men). In contrast, the use of weight-related self-monitoring apps was positively associated with all muscle-building behaviors, including steroids/growth hormone/creatine/amino acids in men (prevalence ratio [PR] = 1.83; 95% confidence interval [CI]: 1.13–2.97) and women (PR = 4.43; 95% CI: 1.68–11.68). Discussion: While most recreational screen time may represent sedentary behaviors not related to muscle-building behaviors, weight-related self-monitoring apps are highly associated with more muscle-building behaviors and could be a future target for interventions to discourage the use of steroids and other harmful muscle-building substances.

Various types of stressors are associated with maladaptive eating, but how the stressor of everyday discrimination (e.g., less respect, poorer service) relates to maladaptive eating and adaptive eating remains unclear. We examined everyday discrimination as a predictor of maladaptive and adaptive eating. Data were collected in a population-based study, Eating and Activity over Time (N = 1410, ages 18–30). Everyday discrimination was categorized as none, low, moderate, or high. Outcomes included maladaptive eating (i.e., overeating and binge eating) and adaptive eating (i.e., intuitive eating and mindful eating). Modified Poisson regressions estimated the prevalence ratios (PRs) for overeating and binge eating associated with everyday discrimination. Linear regressions estimated associations between everyday discrimination and intuitive and mindful eating scores. After adjustment for age, ethnicity/race, gender, and socioeconomic status, moderate and high levels of discriminatory experiences were each associated with a significantly greater prevalence of binge eating (PR = 2.2, [95% CI = 1.3–3.7] and PR = 3.1, [95% CI = 2.0–4.7], respectively) and lower intuitive (β = −0.4, [95% CI = −0.7, −0.2] and β = −0.5 [95% CI = −0.8, −0.3], respectively), and mindful eating scores (β = −0.3, [95% CI = −0.6, −0.1] and β = −0.5 [95% CI = −0.8, −0.3], respectively) compared to young adults with no discriminatory experience. Public health efforts to prevent maladaptive eating and encourage the adoption of adaptive eating should consider the potential contribution of everyday discrimination and the need to advocate for equity and inclusion.

Purpose: Growing evidence indicates that experiencing household food insecurity during adolescence is associated with disordered eating and elevated body mass index (BMI). However, little is known about the temporal nature of these relationships. The current longitudinal study examined how adolescent experiences of household food insecurity are related to disordered eating and weight status 8 years later. Methods: A population-based sample of ethnically/racially and socioeconomically diverse participants (n = 1,340) were surveyed as adolescents (mean age = 14.5 years) and as young adults (mean age = 22.0 years). Parents/caregivers completed the six-item U.S. Household Food Security Survey Module at baseline. Results: Household food insecurity was common at baseline (37.8% of sample). In analyses adjusted for ethnicity/race and parental education, adolescent food insecurity longitudinally predicted a higher new onset of binge eating (food insecure: 21.3% vs. food secure: 16.2%, p = .038) and BMI ≥30 kg/m2 (food insecure: 15.9% vs. food secure: 11.0%, p = .024), but not unhealthy weight control behaviors in young adulthood. The majority of adolescents with unhealthy weight control behaviors and elevated BMI still had these problems in young adulthood, but persistence was not associated with adolescent household food insecurity for any outcome. Discussion: Results of this longitudinal study suggest that household food insecurity during adolescence is a risk factor for disordered eating and elevated BMI in young adulthood, highlighting a need to comprehensively address these intersecting problems.

Use of weight-related self-monitoring (WRSM) apps is common among emerging adults, as are weight and shape concerns. The present study aimed to examine (1) whether emerging adult use of dietary-focused (e.g., MyFitnessPal) and physical activity-focused (e.g., Fitbit) WRSM apps was associated with weight-control and muscle-building behaviors, including commonly recommended/conventional behaviors and disordered behaviors and (2) whether prior use of weight-control and muscle-building behaviors in adolescence might explain such relationships. Data were collected as part of the EAT (Eating and Activity over Time) 2010–2018 study (n = 1446) and analyzed using gender-stratified logistic regression models adjusted for demographic characteristics and body mass index. Among women and men, physical activity- and dietary-focused app use were associated with greater adjusted prevalence of disordered weight-control behaviors (e.g., fasting, purging), and disordered muscle-building behaviors (e.g., using steroids). Physical activity- and dietary-focused app use were also associated with a higher adjusted prevalence of commonly recommended weight-control and conventional muscle-building behaviors (e.g., exercising, changing eating habits), but only among those who were also engaging in disordered behaviors. The observed associations remained statistically significant in models that further adjusted for adolescent use of the respective behaviors. Findings suggest that emerging adults who use physical activity- and dietary-focused WRSM apps are more likely to engage in disordered weight-control and muscle-building behaviors and that associations are not explained by engagement in these behaviors during adolescence. Future research is needed to examine if there are aspects of WRSM apps that could be modified to reduce potential harm.

Background: Primary care is a frequent source of pain treatment and opioid prescribing. The objective of the Prescribing Interventions for Chronic Pain using the Electronic health record (PRINCE) study is to assess the effects of two behavioral economics-informed interventions embedded within the electronic health record (EHR) on guideline-concordant pain treatment and opioid prescribing decisions in primary care settings. Methods: Setting: The setting for this study is 43 primary care clinics in Minnesota. Design: The PRINCE study uses a cluster-randomized 2 × 2 factorial design to test the effects of two interventions. An adaptive design allows for the possibility of secondary randomization to test if interventions can be titrated while maintaining efficacy. Interventions: One intervention alters the "choice architecture" within the EHR to nudge clinicians toward non-opioid treatments for opioid-naïve patients and toward tapering for patients currently receiving a "high risk" opioid. The other intervention integrates the prescription drug monitoring program (PDMP) directly within the EHR. Outcome: The primary outcome for opioid-naïve patients is whether an opioid is prescribed in a primary care visit without a non-opioid alternative pain treatment. The primary outcome for current opioid-using patients is whether opioid prescriptions were tapered with a documented rationale. Discussion: The PRINCE study will provide real-world evidence on two approaches to improving pain treatment in primary care using the EHR. The adaptive study design strikes a balance between establishing intervention efficacy and testing whether efficacy varies with intervention intensity.

Background: Primary care is a frequent source of pain treatment and opioid prescribing. The objective of the Prescribing Interventions for Chronic Pain using the Electronic health record (PRINCE) study is to assess the effects of two behavioral economics-informed interventions embedded within the electronic health record (EHR) on guideline-concordant pain treatment and opioid prescribing decisions in primary care settings. Methods: Setting: The setting for this study is 43 primary care clinics in Minnesota. Design: The PRINCE study uses a cluster-randomized 2 × 2 factorial design to test the effects of two interventions. An adaptive design allows for the possibility of secondary randomization to test if interventions can be titrated while maintaining efficacy. Interventions: One intervention alters the "choice architecture" within the EHR to nudge clinicians toward non-opioid treatments for opioid-naïve patients and toward tapering for patients currently receiving a "high risk" opioid. The other intervention integrates the prescription drug monitoring program (PDMP) directly within the EHR. Outcome: The primary outcome for opioid-naïve patients is whether an opioid is prescribed in a primary care visit without a non-opioid alternative pain treatment. The primary outcome for current opioid-using patients is whether opioid prescriptions were tapered with a documented rationale. Discussion: The PRINCE study will provide real-world evidence on two approaches to improving pain treatment in primary care using the EHR. The adaptive study design strikes a balance between establishing intervention efficacy and testing whether efficacy varies with intervention intensity.

Purpose: This study was designed to examine (1) the types of technologies or other applications (apps) emerging adults use to track their eating, physical activity, or weight; (2) who uses these apps and (3) whether eating and weight-related concerns during adolescence predict app use in emerging adulthood. Methods: Longitudinal survey data were obtained from EAT 2010–2018 (Eating and Activity over Time study, N = 1428), a population-based sample of ethnically/racially and socioeconomically diverse adolescents (mean age: 14.5 ± 2.0 years), who were followed into emerging adulthood (mean age: 22.0 ± 2.0 years). Data were used to examine sociodemographic correlates of physical activity- and dietary-focused app use. Adjusted, gender-stratified logistic regressions were used to investigate longitudinal relationships between eating and weight-related concerns in adolescence and app use in emerging adulthood. Results: Compared to men, women were more likely to use physical activity- (23.2 versus 12.5%, p < 0.001) and dietary-focused apps (16.1 versus 5.5%, p < 0.001). Among women, eating and weight-related concerns in adolescence, particularly unhealthy muscle-building behaviors (OR = 1.73, 95% CI 1.03–2.92), were associated with later dietary-focused app use. Among men, use of other muscle-building behaviors and body dissatisfaction in adolescence predicted use of physical activity- (ORother muscle-building = 1.60, 95% CI 1.03–2.49 and ORbody dissatisfaction = 1.67, 95% CI 1.06–2.65) and dietary-focused (ORother muscle-building = 2.18, 95% CI 1.07–4.47 and ORbody dissatisfaction = 2.35, 95% CI 1.12–4.92) apps 8 years later. Conclusions: Eating and weight-related concerns may predict later use of physical activity- and dietary-focused apps; future research is needed to understand whether use of such apps further increases eating and weight-related concerns. Level of evidence: III, well-designed longitudinal cohort study.