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Cochrane AC, Bullington BW, Prokopowicz C, Rahangdale L, Knittel AK. Comparing Cervical Cancer Screening Strategies in an Incarcerated Population. J Womens Health (Larchmt) 2024. [PMID: 38607557 DOI: 10.1089/jwh.2023.0513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024] Open
Abstract
Objective: To describe the prevalence of cervical intraepithelial neoplasia (CIN), high-risk human papillomavirus (hrHPV) infection, and cervical cancer in a high-risk, underscreened incarcerated population and to evaluate the performance of current cervical cancer screening options to detect cervical precancer (CIN 2/3) in this population. Study Design: Deidentified data were obtained from all cytological, hrHPV DNA, and histopathological testing of cervical biopsies performed on people incarcerated at the North Carolina Correctional Institute for Women between January 1, 2013, and December 31, 2020. These were linked to corresponding demographic data. The proportions of histopathological diagnoses of CIN2+ and CIN3+ immediately preceded by abnormal cytology testing or hrHPV testing were determined, and prevalence differences and 95% confidence intervals were calculated. Results: A total of 15,319 individuals incarcerated at the North Carolina Correctional Institute for Women had at least one cytology result during 2013-2020. Of these, 2,829 (18%) had abnormal cervical cytology, and 3,724 (24.3%) had positive hrHPV testing. The detection of CIN2+ was 95.9% by preceding abnormal cervical cytology, 89.9% by preceding positive hrHPV testing (p = 0.03), and 96.5% by preceding positive co-testing. The detection rate of CIN3+ was 96.6% by preceding abnormal cervical cytology, 90.8% by preceding positive hrHPV testing (p = 0.12), and 96.6% by positive co-testing. Conclusion: In our sample, primary cytology and co-testing detected CIN2+ at higher rates when compared with primary hrHPV testing. This reinforces that incarcerated populations do not fall into average-risk populations for which current cervical cancer screening options are designed, which should be considered when performing screening in this population.
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Affiliation(s)
- Anna Caroline Cochrane
- Department of Obstetrics and Gynecology, Wake Forest University Health Sciences, Winston-Salem, North Carolina, USA
| | - Brooke W Bullington
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Caroline Prokopowicz
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Lisa Rahangdale
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
- University of North Carolina at Chapel Hill Lineberger Cancer Research Center, Chapel Hill, North Carolina, USA
| | - Andrea K Knittel
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
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Davis KM, Tolleson-Rinehart S, Knittel AK. Care Transitions for Incarcerated Pregnant People: A Needs Assessment. J Correct Health Care 2024; 30:135-143. [PMID: 38484310 DOI: 10.1089/jchc.23.06.0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
Incarcerated pregnant people face significant barriers when seeking health care services in prisons and jails, but little is known about their transitions from state prison health care systems to outside hospitals. This project analyzed current policies and procedures for care transitions for incarcerated people and presents policy recommendations to address issues of concern. We conducted in-depth interviews with stakeholders at a state prison, academic hospital, and private hospital to identify the barriers and facilitators to care transitions. Themes emerging from these interviews were operational, including medical records, communication, and education; and structural, including implicit biases and care of marginalized groups. These findings are likely applicable to similar facilities throughout the United States. A multipronged, interdisciplinary approach is needed to address challenges of care transitions.
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Affiliation(s)
- Katherine M Davis
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Sue Tolleson-Rinehart
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina USA
| | - Andrea K Knittel
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
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3
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Daubert EM, Dionne J, Atrio J, Knittel AK, Kassaye SG, Seidman D, Long A, Brockmann S, Ofotokun I, Fischl MA, Massad LS, Weber KM. Declining Prevalence of Trichomonas vaginalis Diagnosed by Wet Mount in a Cohort of U.S. Women With and Without HIV. J Womens Health (Larchmt) 2024; 33:388-395. [PMID: 38215275 PMCID: PMC10924113 DOI: 10.1089/jwh.2023.0263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024] Open
Abstract
Background: Women living with HIV (WLWH) are often coinfected with Trichomonas vaginalis (TV), and annual screening is recommended. Our goal was to assess differences in TV prevalence at study entry and over time in enrollment cohorts of the Women's Interagency HIV Study. Methods: In a multisite study, TV was diagnosed by wet mount microscopy. Prevalence was determined across four enrollment waves: 1994-1995, 2001-2002, 2011-2012, and 2013-2015. Generalized estimating equation multivariable logistic regression models assessed changes in visit prevalence across waves after controlling for HIV disease severity and other risks. Results: At 63,824 person-visits (3,508 WLWH and 1,262 women without HIV), TV was diagnosed by wet mount at 1979 visits (3.1%). After multivariable adjustment, HIV status was not associated with TV detection, which was more common among younger women, women with multiple partners, and irregular condom use. All enrollment waves showed a decline in TV detection over time, although p-value for trend did not reach significance for most recent waves. To explore the potential utility of screening among WLWH, we assessed rates of TV detection among women without appreciable vaginal discharge on examination. Initial TV prevalence among asymptomatic women was 3.5%, and prevalence decreased to 0.5%-1% in the most recent wave (2013-2015) (p-trend <0.0001). Conclusions: In this cohort, TV rates are low among WLWH, and HIV does not increase TV risk. Screening may benefit newly diagnosed WLWH, women with risk factors, or those receiving care sporadically but is unlikely to further reduce the low rate of TV among women in care, especially older women without multiple partners. The clinical trials registration number for WIHS is NCT00000797.
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Affiliation(s)
| | - Jodie Dionne
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jessica Atrio
- Montefiore Hospital & Albert Einstein College of Medicine, Bronx, New York, USA
| | - Andrea K. Knittel
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Seble G. Kassaye
- Department of Medicine, Georgetown University, Washington, District of Columbia, USA
| | - Dominika Seidman
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
| | - Amanda Long
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Susan Brockmann
- State University of New York (SUNY) Health Sciences University, Brooklyn, New York, USA
| | - Igho Ofotokun
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Margaret A. Fischl
- Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - L. Stewart Massad
- Department of Obstetrics & Gynecology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Kathleen M. Weber
- Cook County Health/Hektoen Institute of Medicine, Chicago, Illinois, USA
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McCrary LM, Cox ME, Roberts KE, Knittel AK, Jordan RA, Proescholdbell SK, Schranz AJ. Endocarditis, drug use and biological sex: A statewide analysis comparing sex differences in drug use-associated infective endocarditis with other drug-related harms. Int J Drug Policy 2024; 123:104280. [PMID: 38103457 PMCID: PMC10843756 DOI: 10.1016/j.drugpo.2023.104280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 11/20/2023] [Accepted: 11/25/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVES Hospitalizations for drug use-associated infective endocarditis (DUA-IE) have risen sharply across the United States over the past decade. The sex composition of DUA-IE remains less clear, and studies have indicated a possible shift to more females. We aimed to compare more recent statewide hospitalization rates for DUA-IE in females versus males and contextualize them among other drug-related harms in North Carolina (NC). METHODS This study was a retrospective analysis using public health datasets of all NC hospital discharges for infective endocarditis from 2016 to 2020. Drug use-related hospitalizations were identified using ICD-10-CM codes. Discharge rates by year and sex for DUA-IE and non-DUA-IE were calculated and compared to fatal overdoses and acute hepatitis C (HCV). Temporal, demographic, and pregnancy trends were also assessed. RESULTS Hospitalizations rates for DUA-IE were 9.7 per 100,000 over the five-year period, and 1.2 times higher among females than males. Females composed 57% of DUA-IE hospitalizations over the period. Conversely, fatal overdose, acute HCV, and non-DUA-IE hospitalization rates were higher among males. Age, county of residence, and pregnancy status did not explain the higher DUA-IE among females. CONCLUSION Females now comprise the majority of DUA-IE hospitalizations in NC, unlike other drug-related harms. No clear demographic or geographic associations were found, and further research is needed to explain this phenomenon. Preventing invasive infections among females who inject drugs should be prioritized.
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Affiliation(s)
- L Madeline McCrary
- Washington University School of Medicine in St. Louis, Department of Medicine, 4523 Clayton Ave MSC 8051-0043-15, St. Louis, MO 63110
| | - Mary E Cox
- North Carolina Department of Health and Human Services, Division of Public Health, 2001 Mail Service Center, Raleigh, NC 27699, USA
| | - Kate E Roberts
- Bryn Mawr College, Graduate School of Social Work and Social Research, 300 Airdale Rd, Bryn Mawr, PA 19010, USA
| | - Andrea K Knittel
- University of North Carolina, Department of Obstetrics and Gynecology, 3009 Old Clinic Building, CB #7570, Chapel Hill, NC 27599, USA
| | - Robyn A Jordan
- University of North Carolina, Department of Psychiatry, 1101 Weaver Dairy Rd Ste 102, Chapel Hill 27514, USA
| | - Scott K Proescholdbell
- North Carolina Department of Health and Human Services, Division of Public Health, 2001 Mail Service Center, Raleigh, NC 27699, USA
| | - Asher J Schranz
- University of North Carolina, Department of Medicine, 130 Mason Farm Rd, CB #7030, Chapel Hill, NC 27599, USA.
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Reddy J, Black K, Bazemore K, Jordan K, Jackson JB, Knittel AK. Ethical inclusion: Risks and benefits of research from the perspective of perinatal people with opioid use disorders who have experienced incarceration. PLoS One 2023; 18:e0294604. [PMID: 37992010 PMCID: PMC10664874 DOI: 10.1371/journal.pone.0294604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 11/03/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Research ethics guidelines and emphasis on representation in research guide the inclusion of marginalized groups, including people with perinatal opioid use disorders (OUD) and people experiencing incarceration in the United States. However, insights from participants regarding the risks and benefits of participation are not adequately considered. The aim of this study was to examine the risks and benefits of research participation from the perspective of pregnant/postpartum people with OUD who have experienced incarceration. DESIGN We recruited people who had experience with perinatal incarceration and were either currently pregnant or postpartum, and at least 18 years old. All participants met the clinical criteria for OUD. Our study did not have exclusion criteria based on gender, race, or ethnicity. SETTING Participants were either currently incarcerated at the North Carolina Correctional Institute for Women in Raleigh, North Carolina, United States or had previously experienced perinatal incarceration and were recruited from a perinatal substance use disorder treatment program located in North Carolina. PARTICIPANTS Between 9/2021-4/2022, we completed 12 interviews with pregnant/postpartum people with OUD, approximately half who were currently incarcerated and half with a recent history of perinatal incarceration. INTERVENTION/MEASUREMENT Interviews were conducted via Webex phone or video. The interviews followed a scripted interview guide and lasted one hour on average. Interview transcripts were analyzed using the Rigorous and Accelerated Data Reduction technique to produce an overarching thematic framework. FINDINGS Our analysis identified benefits, including the personal advantage of self-expression, helping others and contributing to change, and financial incentives. Risks included stigma and breach of confidentiality, misunderstanding of the distinction between research and advocacy, and limited ability to share their whole experience. CONCLUSIONS Participant-identified benefits of research mirrored those from other marginalized populations, though participant-identified risks were novel and nuanced. Recruitment and consent should move beyond normative research ethics committees protocol language to consider the perspectives of participants.
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Affiliation(s)
- Julia Reddy
- Department of Maternal Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Kristel Black
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States of America
| | - Keia Bazemore
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States of America
| | - Kiva Jordan
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States of America
| | - Jamie B. Jackson
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States of America
| | - Andrea K. Knittel
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States of America
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Busse CE, Latour CD, Dejene SZ, Knittel AK, Wood ME, Kinlaw AC, Dissanayake MV. Incidence of new outpatient long-acting reversible contraceptive insertions among a commercially insured, US population from 2010 to 2020. Contracept X 2023; 5:100101. [PMID: 37823033 PMCID: PMC10562738 DOI: 10.1016/j.conx.2023.100101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 09/07/2023] [Accepted: 09/13/2023] [Indexed: 10/13/2023] Open
Abstract
Objectives Characterize new use of long-acting reversible contraceptives (LARCs), highly effective contraceptive methods, in a broad population over time. Study Design We constructed a retrospective cohort of commercially insured individuals aged 15 to 54 years from 2010 to 2020 and estimated monthly incidence of new LARC insertions. Results The monthly standardized incidence increased from 6.0 insertions per 10,000 individuals in January 2010 to 14.1 in December 2020, with a dip in insertions after March 2020. Hormonal intrauterine devices were consistently the most inserted LARC; implants were increasingly favored over time. Conclusions LARCs are increasingly popular forms of contraception among commercially insured individuals. Implications Given the increasing popularity, ensuring access to LARCs is critical.
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Affiliation(s)
- Clara E. Busse
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Chase D. Latour
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Sara Z. Dejene
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Andrea K. Knittel
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Mollie E. Wood
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Alan C. Kinlaw
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina School of Pharmacy, Chapel Hill, NC, United States
| | - Mekhala V. Dissanayake
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Knittel AK, Swartzwelder RA, Zarnick S, Tsujimoto TM, Horne T, Lin FC, Edwards J, Amos E, Alexander J, Thorp J, Jones HE. Neonatal Outcomes after Medications for Opioid Use Disorder during Pregnancy in a State Women's Prison Facility, 2016-2019. J Addict Med 2023; 17:587-591. [PMID: 37788614 PMCID: PMC10593980 DOI: 10.1097/adm.0000000000001184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Although medications for opioid use disorder improve both maternal and neonatal outcomes, little is known about opioid-exposed infants born during episodes of incarceration. The study sought to examine birth outcomes for infants born with opioid exposure during perinatal incarceration. METHODS Participants were identified from clinic rosters in a Southeastern women's prison (2016-2019). Included infants born to pregnant people with opioid use disorder incarcerated in the study facility at the time of delivery. We abstracted hospital length of stay, neonatal opioid withdrawal syndrome (NOWS) severity, and discharge plan from hospital records and report descriptive statistics, analysis of variance F tests, and chi-square tests to compare outcomes by opioid exposure type. RESULTS There were 125 infants born after exposure to methadone (n = 34), buprenorphine (n = 15), oxycodone (n = 22), or no opioid medication (n = 54) during prenatal incarceration. Most infants exposed to methadone or buprenorphine had difficulty with eating, sleeping, or consoling (97% and 80%), and 59% and 47% were treated with medication for NOWS, respectively. The majority with prenatal opioid exposure required intervention for NOWS symptoms after their birthing parent was discharged to the prison. The average hospital length of stay was different for infants with no opioid, methadone, buprenorphine, and oxycodone exposure during incarceration (4, 15, 12, and 9 days, respectively, P < 0.001). CONCLUSIONS Neonatal hospitalization experiences of infants with perinatal opioid exposures during maternal incarceration mirror those of similarly exposed infants born outside the context of incarceration, except for hospital length of stay. Consideration of avoiding separation of the parent-infant dyad may be needed to improve outcomes for these infants.
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Affiliation(s)
- Andrea K Knittel
- Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Rita A Swartzwelder
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Samantha Zarnick
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Tamy Moraes Tsujimoto
- Department of Biostatistics, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Timeli Horne
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Feng Chang Lin
- Department of Biostatistics, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Elton Amos
- North Carolina Department of Public Safety, Raleigh, NC
| | | | - John Thorp
- Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Hendree E Jones
- UNC Horizons, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
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Burkett WC, Iwai Y, Gehrig PA, Knittel AK. Fractured and delayed: A qualitative analysis of disruptions in care for gynecologic malignancies during incarceration. Gynecol Oncol 2023; 176:1-9. [PMID: 37393632 PMCID: PMC10528285 DOI: 10.1016/j.ygyno.2023.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/13/2023] [Accepted: 06/21/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE Women are experiencing growing rates of incarceration at twice the pace of that for men. Additionally, one-third will be older than 55 years of age by the end of the decade. Women who are incarcerated experience a higher prevalence of gynecologic malignancies and present with higher stage disease, which may be contributing to the greater mortality from cancer than the age-adjusted US population. Limited access to guideline-recommended screening and prevention and resource limitations across correctional facilities may result in gynecologic cancer disparities. Reasons for delayed gynecologic cancer care in prisons remain underexplored. Therefore, we sought to identify contributors to delayed gynecologic cancer care among women experiencing incarceration. METHODS Women at a single tertiary center in the Southeastern U.S. who were incarcerated and were diagnosed with a gynecologic cancer during 2014-2021 were identified in the electronic medical record. Note text was extracted and contributors to delay were identified and categorized using the RADaR method. Descriptive statistics were used to assess quantitative data. RESULTS 14 patients were identified with a total of 14,879 text excerpts. Data reduction was performed to identify excerpts that were relevant to the central research question resulting in 175 relevant note excerpts. Delays prior to the tertiary care visit included patient and institutional contributors. Delays during transition from the tertiary center to prison included discharge planning and loss to follow-up during/after incarceration. Transportation, authorization, and restraints were concrete contributors. Abstract contributors included communication, and the patient's emotional experience. CONCLUSIONS We identify myriad contributors to delayed or fractured gynecologic cancer care in women experiencing incarceration. The impact of these issues warrants further study and intervention to improve care.
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Affiliation(s)
- Wesley C Burkett
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America.
| | - Yoshiko Iwai
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States of America.
| | - Paola A Gehrig
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, VA, United States of America.
| | - Andrea K Knittel
- Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America.
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Knittel AK, Jackson JB, Swartzwelder RA, Ferguson EG, Hulshult H, Adimora AA. PrEP and HIV prevention decision-making among social network members of women who have experienced incarceration: a qualitative study. AIDS Care 2023; 35:1375-1385. [PMID: 36912643 PMCID: PMC10363199 DOI: 10.1080/09540121.2023.2182872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 02/14/2023] [Indexed: 03/14/2023]
Abstract
ABSTRACTIncarceration and HIV are a syndemic for US women, yet very few women who have experienced incarceration use pre-exposure prophylaxis (PrEP) for HIV. We conducted semi-structured interviews with 32 participants recruited by women who have experienced incarceration from their social networks, informed by the modified social ecological model for PrEP. Emergent themes from the interviews included individual-level (low personal HIV risk assessment, personal responsibility for HIV prevention, and decisions in addiction versus recovery), network-level (influential sex partners and the importance of trust, supportive treatment peers, and high-risk but indifferent drug use networks), community-level (stigma, and mitigation of stigma in supportive substance use disorder treatment environments), and public policy-level (incarceration and PrEP cost and access) determinants. PrEP interventions for women who have experienced incarceration and their networks will need to incorporate contingency planning into HIV risk assessment, navigate complex network dynamics, and be situated in trusted contexts to address structural barriers.
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Affiliation(s)
- Andrea K. Knittel
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC USA
| | - Jamie B. Jackson
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC USA
| | - Rita A. Swartzwelder
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill NC USA
| | - Ella G. Ferguson
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC USA
| | - Hannah Hulshult
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill NC USA
| | - Ada A. Adimora
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill School of Medicine, NC, USA
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10
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Knittel AK, Ferguson EG, Jackson JB, Adimora AA. The influence of social relationships on PrEP attitudes among women with incarceration experience in the Southeastern USA. Cult Health Sex 2023; 25:110-125. [PMID: 35015606 PMCID: PMC9271531 DOI: 10.1080/13691058.2021.2023760] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 12/24/2021] [Indexed: 06/14/2023]
Abstract
Women who have experienced incarceration face a disproportionately high risk of acquiring HIV. Despite efficacy of pre-exposure prophylaxis (PrEP) for HIV, very few women with incarceration histories are using PrEP. Our objective was to learn how sexual, drug-use and social relationships shape decisions about PrEP among women who have experienced incarceration. We used an inductive approach to analyse data from four focus groups undertaken with women who had previously experienced incarceration recruited from three community-based organisations. We identified public policy (medical distrust, lack of prevention in prisons and jails, and cost and coverage of PrEP); community (incarceration stigma, gossip as prevention); social and sexual network (positive peer and parenting relationships, distrust of sexual partners, and networks as a source of risk); and individual-level (active addiction or recovery, change after incarceration, and medical concerns) factors influencing the use of PrEP. Actions and interventions to improve PrEP uptake among women who have experienced incarceration must take account of the multilevel context of HIV prevention decisions.
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Affiliation(s)
- Andrea K. Knittel
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Ella G. Ferguson
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Jamie B. Jackson
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Adaora A. Adimora
- Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
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Nguyen A, Shadowen H, Shadowen C, Thakkar B, Knittel AK, Martin CE. Incarceration status at buprenorphine initiation and OUD treatment outcomes during pregnancy. Front Psychiatry 2023; 14:1157611. [PMID: 37124262 PMCID: PMC10133465 DOI: 10.3389/fpsyt.2023.1157611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/27/2023] [Indexed: 05/02/2023] Open
Abstract
Introduction Opioid use disorder (OUD) is a leading cause of pregnancy-associated deaths. OUD treatment with buprenorphine (BUP) reduces overdose risk and improves perinatal outcomes. Incarceration can be a barrier to receipt of OUD treatment during pregnancy and postpartum. The objective of this study was to examine differences in BUP continuation at delivery by patients' incarceration status at the time of BUP initiation. Methods This is a secondary analysis of a retrospective cohort study of pregnant patients with OUD who delivered at an academic medical center and initiated BUP between January 1, 2018, and March 30, 2020. The primary outcome was BUP continuation at delivery, abstracted from the state prescription monitoring program and electronic medical record, along with incarceration status. Bivariate analysis was used to assess the relationship between BUP continuation and incarceration status. Results Our sample included 76 patients, with 62% of patients incarcerated at BUP initiation (n = 47). Among the entire sample, 90.7% (n = 68) received BUP at delivery. Among patients who were incarcerated at BUP initiation, 97% remained on BUP at delivery; among patients who were not incarcerated at BUP initiation, 79% remained on BUP at delivery (p = 0.02). Conclusion In our sample from a health system housing a care model for pregnant and parenting people with OUD with local jail outreach, BUP continuation rates at delivery were high, both for patients who were and were not incarcerated at BUP initiation. Findings are intended to inform future work to develop and evaluate evidence-based, patient-centered interventions to expand OUD treatment access for incarcerated communities.
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Affiliation(s)
- Andrea Nguyen
- School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Hannah Shadowen
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA, United States
| | - Caroline Shadowen
- Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, VA, United States
| | - Bhushan Thakkar
- Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, VA, United States
| | - Andrea K. Knittel
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Caitlin E. Martin
- Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, VA, United States
- Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, United States
- *Correspondence: Caitlin E. Martin,
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12
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Arant EC, Walker A, Knittel AK, Ashkin EA, Lauren BR, White BL. 2078. Barriers and Facilitators to the HIV (PrEP) Care Continuum: Perspectives of Key Stakeholders and Formerly Incarcerated Individuals. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.1700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
Recently incarcerated individuals are at increased risk for HIV acquisition during community re-entry but have poor access to HIV pre-exposure prophylaxis (PrEP). There is an opportunity to integrate PrEP into an existing Formerly Incarcerated Transition (FIT) program in North Carolina (NC). We aimed to explore potential barriers and facilitators to post release PrEP implementation within the existing FIT program from the perspectives of formerly incarcerated individuals (FIT clients) and community stakeholders (community health clinicians, community health workers).
Methods
We conducted 28 semi-structured in-depth interviews (14 FIT clients and 14 community stakeholders). We used a rapid assessment method to summarize interview transcripts based on the domains of the semi-structured interview guide and to characterize the contents of the summaries as potential barriers or facilitators to steps of the PrEP cascade.
Results
HIV stigma was mentioned as a potential barrier at each step of the PrEP cascade among both FIT clients and stakeholders. Both groups emphasized the importance of PrEP education for FIT clients, stakeholders, and the community to facilitate awareness and HIV risk perception. Stakeholders and FIT clients believed that competing priorities would be a significant barrier to PrEP uptake post-release. Linking incarcerated individuals to PrEP services during incarceration was mentioned as a facilitator to increase PrEP uptake. A lack of ongoing social support was seen as a critical barrier by FIT clients to achieve the necessary adherence to PrEP and retention to PrEP appointments. Both groups cited financial and logistical challenges such as the cost of PrEP services and transportation as potential barriers to PrEP adherence and retention.
Conclusion
Community stakeholders and FIT clients recommended several strategies that can be implemented to increase PrEP knowledge, uptake, and retention upon release. However, they also identified critical structural barriers that must be overcome before PrEP can be adopted among formerly incarcerated individuals in a non-Medicaid expansion state.
Disclosures
All Authors: No reported disclosures.
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Affiliation(s)
- Elizabeth C Arant
- University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Abbey Walker
- University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Andrea K Knittel
- University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Evan A Ashkin
- University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | | | - Becky L White
- University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
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13
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King Z, Lyerly AD, Knittel AK. Safekeeping of Pregnant People Experiencing Incarceration. Women Crim Justice 2022; 33:363-377. [PMID: 37789904 PMCID: PMC10545335 DOI: 10.1080/08974454.2022.2104986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Safekeeping involves transferring individuals from jails to prisons without the presence of a conviction. In North Carolina, safekeeping is used for pregnant people with the aim of providing better prenatal care. We interviewed 14 stakeholders in the safekeeping process including sheriffs, clinicians, advocates, and lawyers. Three key themes emerged: jails' inability to provide care for pregnant individuals; safekeeping as an additional punishment to incarceration; and differing attitudes on the necessity of safekeeping. Participants perceived that while there may be some benefits of safekeeping such as enhanced prenatal care, safekeeping can also lead to worsened conditions for pregnant people experiencing incarceration.
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Affiliation(s)
- Zoe King
- Duke University, Trinity College of Arts & Sciences; 117 Physics Building; 120 Science Dr.; Durham, NC 27708; United States
| | - Anne D. Lyerly
- University of North Carolina at Chapel Hill School of Medicine, Department of Social Medicine, 333 South Columbia St, 333 MacNider Hall, CB# 7240, Chapel Hill, NC 27599; United States
| | - Andrea K. Knittel
- University of North Carolina at Chapel Hill Department of Obstetrics and Gynecology; 3027 Old Clinic Building, CB#7570, Chapel Hill, NC 27599
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14
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Bullington BW, Edmonds A, Ramirez C, Rahangdale L, Neal-Perry G, Konkle-Parker D, Weiss DJ, Moran C, Golub ET, Cejtin H, Seidman D, Kassaye S, Wilson TE, Sharma A, Adimora AA, Knittel AK. Premature and early menopause among US women with or at risk for HIV. Menopause 2022; 29:741-747. [PMID: 35324546 PMCID: PMC9177513 DOI: 10.1097/gme.0000000000001964] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Little is known about the prevalence and treatment of premature and early menopause among people with HIV. We described premature and early menopause and subsequent hormonal treatment in a longitudinal cohort of women living with or at risk for HIV in the US. METHODS Data from the Women's Interagency HIV Study between 2008 and 2020 were analyzed to describe premature and early menopause among cohort participants under the age of 51. RESULTS Of 3,059 eligible women during the study period, 1% (n = 35) underwent premature menopause before age 41, 3% (n = 101) underwent menopause between ages 41 and 46, and 21% (n = 442) underwent menopause between ages 46 and 50, inclusive. Of participants who experienced menopause before age 41, between age 41 and 45, and between ages 46 and 50, 51%, 24%, and 7% (respectively) received either menopausal hormone therapy or hormonal contraception. CONCLUSION These findings suggest that disparities in receipt of recommended hormone therapy for premature and early menopause may contribute, in part, to evident health disparities, such as cardiovascular disease, osteoporosis, and overall mortality. They also suggest a substantial need for education among people experiencing early menopause and their providers, with the goal of improving access to hormone therapy based on guidelines to address health disparities and minimize future health consequences.
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Affiliation(s)
- Brooke W Bullington
- From the department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Andrew Edmonds
- From the department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Catalina Ramirez
- Institute for Global Health & Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Lisa Rahangdale
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Genevieve Neal-Perry
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Deborah Konkle-Parker
- Department of Medicine, Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS
| | - Deborah Jones Weiss
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Caitlin Moran
- Department of Medicine, Division of Infectious Disease, Emory University, Atlanta, GA
| | - Elizabeth Topper Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Helen Cejtin
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, John H. Stroger Jr. Hospital of Cook County, Chicago, IL
| | - Dominika Seidman
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, CA
| | - Seble Kassaye
- Division of Infectious Diseases, Department of Medicine, Georgetown University, Washington DC
| | - Tracey E Wilson
- Department of Community Health Sciences, SUNY Downstate Health Sciences University, Brooklyn, NY
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Adaora A Adimora
- From the department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Institute for Global Health & Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Andrea K Knittel
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
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15
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Prost SG, Golembeski C, Periyakoil VS, Arias J, Knittel AK, Ballin J, Oliver HD, Tran NT. Standardized outcome measures of mental health in research with older adults who are incarcerated. Int J Prison Health 2022; ahead-of-print:10.1108/IJPH-08-2021-0085. [PMID: 35362688 PMCID: PMC9328480 DOI: 10.1108/ijph-08-2021-0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The targeted use of standardized outcome measures (SOMs) of mental health in research with older adults who are incarcerated promotes a common language that enables interdisciplinary dialogue, contributes to the identification of disparities and supports data harmonization and subsequent synthesis. This paper aims to provide researchers with rationale for using "gold-standard" measures used in research with community-dwelling older adults, reporting associated study sample psychometric indexes, and detailing alterations in the approach or measure. DESIGN/METHODOLOGY/APPROACH The authors highlight the mental health of older adults who are incarcerated. They also discuss the benefits of SOMs in practice and research and then identify gold-standard measures of mental health used in research with community-dwelling older adults and measures used in research with older adults who are incarcerated. Finally, the authors provide several recommendations related to the use of SOMs of mental health in research with this population. FINDINGS Depression, anxiety and post-traumatic stress disorder are common among older adults who are incarcerated. Researchers have used a variety of measures to capture these mental health problems, some parallel to those used with community-dwelling samples. However, a more targeted use of SOMs of mental health in research with this population will contribute to important strides in this burgeoning field. ORIGINALITY/VALUE This review offers several practical recommendations related to SOMs of mental health in research with older adults who are incarcerated to contribute to a rigorous evidence base and thus inform practice and potentially improve the health and well-being of this population.
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Affiliation(s)
- Stephanie Grace Prost
- Raymond A. Kent School of Social Work, University of Louisville, Louisville, Kentucky, USA
| | - Cynthia Golembeski
- Milano School of Policy, Management, and Environment, The New School, New York, New York, USA
| | | | - Jalayne Arias
- University of California San Francisco, San Francisco, California, USA
| | - Andrea K Knittel
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Jessica Ballin
- Department of Health Promotion and Sports Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Heather D Oliver
- Raymond A. Kent School of Social Work, University of Louisville, Louisville, Kentucky, USA
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16
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Knittel AK, Rudolph JE, Shook-Sa BE, Edmonds A, Ramirez C, Cohen M, Taylor T, Adedimeji A, Michel KG, Milam J, Cohen J, Donohue JD, Foster A, Fischl MA, Long DM, Adimora AA. Self-Reported Sexually Transmitted Infections After Incarceration in Women with or at Risk for HIV in the United States, 2007-2017. J Womens Health (Larchmt) 2022; 31:382-390. [PMID: 34967695 PMCID: PMC8972014 DOI: 10.1089/jwh.2021.0215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background: U.S. women who have been incarcerated report high rates of sexual risk behavior and sexually transmitted infections (STIs). Materials and Methods: We estimated the effect of incarceration on the time to first incident STI in a multicenter cohort of U.S. women with or at risk for HIV. We used marginal structural models to compare time to first self-reported gonorrhea, chlamydia, or trichomonas infection for nonincarcerated women and incarcerated women. Covariates included demographic factors, HIV status, sex exchange, drug/alcohol use, and prior incarceration. Results: Three thousand hundred twenty-four women contributed a median of 4 at-risk years and experienced 213 first incident STI events. The crude incidence of STIs was 3.7 per 100 person-years for incarcerated women and 1.9 per 100 person-years for nonincarcerated women. The weighted hazard ratio for incident STIs was 4.05 (95% confidence interval: 1.61-10.19). Conclusion: Women with or at risk for HIV in the United States who have recently experienced incarceration may be at increased STI risk.
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Affiliation(s)
- Andrea K Knittel
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Jacqueline E Rudolph
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Bonnie E Shook-Sa
- Department of Biostatistics, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Andrew Edmonds
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Catalina Ramirez
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina. USA
| | | | - Tonya Taylor
- Division of Infectious Disease, College of Medicine at SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Katherine G Michel
- Department of Infectious Diseases, Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Joel Milam
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | - Jennifer Cohen
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jessica D Donohue
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Antonina Foster
- Division of Infectious Disease, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Margaret A Fischl
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Dustin M Long
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Adaora A Adimora
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina. USA
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17
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Knittel AK, Ferguson EG, Balasubramanian V, Carda-Auten J, DiRosa E, Rosen DL. " We don't wanna birth it here": A qualitative study of Southern jail personnel approaches to pregnancy. Women Crim Justice 2022; 33:349-362. [PMID: 37873022 PMCID: PMC10588771 DOI: 10.1080/08974454.2022.2040693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Each year, approximately 55,000 pregnant people are incarcerated in US jails. To learn about pregnancy and postpartum care in jails, we analyzed 34 qualitative interviews with jail personnel from facilities in five Southeastern US states. Themes included jail processes unique to pregnancy and burden on jails produced by liability and limited resources. Societal attitudes such as stigma, distrust of pregnant people, and a focus on fetal well-being were also important themes. Jail-community partnerships may mitigate the effects of scarce resources and improve jail perinatal care. Better community safety nets that decrease contact with jails are needed to improve pregnancy outcomes.
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Affiliation(s)
- Andrea K. Knittel
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Ella G. Ferguson
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Jessica Carda-Auten
- Division of Global health and Infectious Disease, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Elena DiRosa
- Division of Global health and Infectious Disease, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - David L. Rosen
- Division of Global health and Infectious Disease, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
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18
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Fayanju OM, Iwai Y, Yu AY, Thomas SM, Knittel AK, Westbrook KE. Abstract P5-14-10: Examining inequities associated with incarceration among patients with breast cancer. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p5-14-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: As of 2020, approximately 2.3 million people were incarcerated in federal and state prisons across the United States (US). Both the total number of individuals experiencing incarceration and the average age of this population have been increasing steadily, raising concerns over the criminal legal system’s capacity to ensure adequate healthcare for this aging and expanding population. People who experience incarceration carry a heavy burden of disease and are more likely to belong to racial and ethnic minority groups. Despite known risk factors, little data exist with regards to treatment patterns and quality of care for breast cancer among these individuals. We sought to examine disease and treatment characteristics among individuals diagnosed with and treated for breast cancer during an episode of incarceration. Methods: We derived our analytic population from patients ≥14 years old who received a breast-cancer diagnosis at the University of North Carolina Hospitals (a tertiary care center) between 4/14/2014 and 12/30/2020. Patient demographics including incarceration status during diagnosis, disease characteristics, and treatment details were summarized with N (%) for categorical variables and median (interquartile range, IQR) for continuous variables. Comparisons were made according to incarceration exposure: never incarcerated (NI) vs diagnosis before incarceration (BI) vs diagnosis during time of incarceration (DI). Differences were tested using the chi-square or Fisher’s exact test for categorical variables and Wilcoxon rank sum or Kruskal-Wallis test for continuous variables. Linear regression was used to estimate the association of incarceration status with time to treatment, modeled separately by treatment sequence (neoadjuvant or upfront surgery). Results: Of the 4332 patients with analyzable data, 34 (0.8%) were either actively incarcerated at time of diagnosis (DI n=24, 70.6%) or were diagnosed before incarceration (BI n=10, 29.4%). Compared to those who were NI or BI, DI patients were more likely to be single (%, DI (50%) vs NI (16.8%) vs BI (10%), p<0.001), more likely to be using illicit drugs at time of diagnosis (%, DI (12.5%) vs NI (1.9%) vs BI (0%), p=0.01), and more likely to have a family history of breast cancer (%, DI (66.7%) vs NI (41.5%) vs BI (30%), p=0.03). There were no differences between DI, NI, and BI patients with regards to race/ethnicity, tumor receptors, or clinical or pathological stage at diagnosis. However, DI patients were less likely to receive neoadjuvant therapy than those who were NI or BI (%, DI (0%) vs NI (8.2%) vs BI (20%), p=0.01). Among patients who received upfront surgery, being incarcerated at time of diagnosis was associated with a time-to-treatment that was 23.4 days longer than that of patients who were never incarcerated (95% CI, 9.5-37.3 days, p=0.001). Conclusion: None of the individuals who were diagnosed with breast cancer during incarceration received neoadjuvant treatment. Among all women who received surgery as their first treatment, diagnosis during incarceration was associated with longer time-to-surgery compared to those never incarcerated. These findings are concerning for missed treatment opportunities within the carceral system. Further research is necessary to understand the full scope of disparities and the systemic factors that contribute to them.
Citation Format: Oluwadamilola Motunrayo Fayanju, Yoshiko Iwai, Alice YunziL Yu, Samantha M Thomas, Andrea K Knittel, Kelly E Westbrook. Examining inequities associated with incarceration among patients with breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P5-14-10.
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Affiliation(s)
| | - Yoshiko Iwai
- The University of North Carolina School of Medicine, Chapel Hill, NC
| | | | | | - Andrea K Knittel
- The University of North Carolina School of Medicine, Chapel Hill, NC
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Scheidell JD, Dyer TV, Knittel AK, Caniglia EC, Thorpe LE, Troxel AB, Lejuez CW, Khan MR. Incarceration and Subsequent Pregnancy Loss: Exploration of Sexually Transmitted Infections as Mediating Pathways. J Womens Health (Larchmt) 2022; 31:242-251. [PMID: 34061656 PMCID: PMC8864438 DOI: 10.1089/jwh.2020.8980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Background: Incarceration is linked to risk of sexually transmitted infection (STI) postrelease among women. There has been little examination of incarceration's association with related sexual and reproductive outcomes such as pelvic inflammatory disease (PID) and pregnancy loss, or the role of STI in this relationship and whether these relationships differ between Black and White women. Methods: Using data from the National Longitudinal Study of Adolescent to Adult Health, we examined cross-sectional associations between incarceration (Wave IV; 2007-2008; ages 24-34) and history of STI and PID (n = 5,968), and longitudinal associations between incarceration and later pregnancy loss in mid-adulthood (Wave V; 2016-2018; ages 34-43) among women who had ever been pregnant (n = 2,353); we estimated racial differences. Using causal mediation, we explored whether STI mediated associations with pregnancy loss. Results: Incarceration was associated with a history of STI (White adjusted prevalence ratio [APR]: 1.54, 95% confidence interval [CI] 1.14-2.06; Black APR: 1.26, 95% CI 1.02-1.56); the association between incarceration and PID was null among White women (APR: 0.99, 95% CI 0.47-2.09) and elevated among Black women (APR: 2.82, 95% CI 1.36-5.83). Prior incarceration did not appear associated with pregnancy loss among White women (APR: 1.01, 95% CI 0.70-1.45), but was associated among Black women (APR: 1.38, 95% CI: 0.97-1.97), with STI appearing to partially mediate. Conclusions: Pregnancy loss may be elevated among Black women who have been incarcerated, and incarceration-related increases in STI may account for some of this association.
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Affiliation(s)
- Joy D. Scheidell
- Division of Comparative Effectiveness and Decision Science, Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA.,Division of Epidemiology, Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA.,Address correspondence to: Joy D. Scheidell, PhD, MPH, Division of Epidemiology, Department of Population Health, New York University Grossman School of Medicine, 227 East 30th Street, Office 624, New York, NY 6402, USA
| | - Typhanye V. Dyer
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Andrea K. Knittel
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ellen C. Caniglia
- Division of Comparative Effectiveness and Decision Science, Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA.,Division of Epidemiology, Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Lorna E. Thorpe
- Division of Comparative Effectiveness and Decision Science, Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA.,Division of Epidemiology, Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Andrea B. Troxel
- Division of Comparative Effectiveness and Decision Science, Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA.,Division of Epidemiology, Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Carl W. Lejuez
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Maria R. Khan
- Division of Comparative Effectiveness and Decision Science, Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA.,Division of Epidemiology, Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
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20
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Jaffe E, Rosen D, Palmquist A, Knittel AK. Menopause-related medication use among women age 45-75 experiencing incarceration in North Carolina 2015-2016. Int J Prison Health 2022. [DOI: 10.1108/ijph-07-2021-0068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This study aims to estimate the prevalence of individuals receiving hormone therapy for menopause management and the prevalence of underlying conditions that may constrain options for pharmacologic menopause management in the prison context.
Design/methodology/approach
This study reviewed all prescriptions dispensed by the North Carolina Department of Public Safety between July 1, 2015, and June 30, 2016, for relevance to menopause management. Relevant medications were those either recommended for menopause management or those indicated for management of conditions that may complicate menopause management, as per the 2015 clinical decision-support algorithm tool developed by the North American Menopause Society. Analysis was restricted to women between the ages of 45 and 75.
Findings
Of 1,120 women, a majority (77.8%) were between the ages of 45 and 54. Less than 5% of individuals in this study were prescribed estrogen-containing therapy. The most commonly prescribed medications that may constrain options for menopause treatment were related to hypertension and other cardiovascular disease or mental health conditions.
Research limitations/implications
The retrospective nature of this data set limits the findings, given that researchers did not have access to diagnoses or data on polypharmacy. Still, this study indicates that many women over 45 experiencing incarceration are living with health conditions that may complicate menopause symptom management with hormone therapy. Future research in carceral settings must examine the prevalence of menopause-related symptoms as well as access to and quality of comprehensive menopause management.
Originality/value
There is a paucity of literature around the menopause-related needs of individuals experiencing incarceration. To the best of the authors’ knowledge, no other research has examined prevalence of pharmacologic menopause management among women who are incarcerated.
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Knittel AK, Shook-Sa BE, Rudolph JE, Edmonds A, Ramirez C, Cohen MH, Adedimeji A, Taylor TN, Michel KG, Milam J, Cohen J, Donohue JD, Foster A, Fischl M, Konkle-Parker D, Adimora AA. Incidence and Prevalence of Incarceration in a Longitudinal Cohort of Women at Risk for Human Immunodeficiency Virus in the United States, 2007-2017. J Womens Health (Larchmt) 2021; 30:694-704. [PMID: 33544023 PMCID: PMC8112715 DOI: 10.1089/jwh.2020.8417] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: To estimate the incidence, prevalence, frequency, and duration of incarceration and to identify risk factors for incarceration among women at risk for human immunodeficiency virus (HIV) in the United States. Methods: During semiannual study visits in a multicenter cohort study, 970 HIV sero-negative participants at risk for HIV were asked about their own incarceration (10/2007-09/2017) and incarceration of sexual partners (10/2013-09/2017). We used descriptive statistics and multivariable log-binomial regression to identify baseline predictors of incident incarceration. Results: Median follow-up time across the 970 participants was 5.5 years (IQR 3.5-9.5). Nearly half (n = 453, 46.7%) of participants were incarcerated during or before the study, and the incarceration rate was 5.5 per 100 person-years. In multivariable models, incident incarceration was associated with prior incarceration (RR 5.20, 95% CI: 3.23-8.41) and noninjection drug use (RR 1.57, 95% CI: 1.10-2.25). Conclusions: Incarceration is common for women at risk for HIV. Prevention interventions that address the complex interplay of drug use, sex exchange, and housing instability for women who have experienced incarceration have the potential to reach an important group of U.S. women at risk of HIV infection.
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Affiliation(s)
- Andrea K. Knittel
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Bonnie E. Shook-Sa
- Department of Biostatistics and University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Jacqueline E. Rudolph
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Andrew Edmonds
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Catalina Ramirez
- Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | | | - Adebola Adedimeji
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Brooklyn, New York, USA
| | - Tonya N. Taylor
- Division of Infectious Disease, SUNY Downstate Medical Center, College of Medicine, Brooklyn, New York, USA
| | - Katherine G. Michel
- Department of Infectious Diseases, Georgetown University, Washington, District of Columbia, USA
| | - Joel Milam
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | - Jennifer Cohen
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jessica D. Donohue
- WIHS Data Management and Analysis Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Antonina Foster
- Division of Infectious Disease, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Margaret Fischl
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Deborah Konkle-Parker
- Division of Infectious Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Adaora A. Adimora
- Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
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Abstract
OBJECTIVE Despite increasing representation of older women in US jail and prison facilities, their menopause experiences and access to related care remain uncharacterized. Our objective is to explore the menopause experiences of women incarcerated in jail and prison facilities. METHODS We conducted a pilot study of four semi-structured in-depth interviews with women in the community who experienced menopause symptoms while incarcerated in either a prison or jail facility. RESULTS Preliminary findings suggest critical gaps in access to menopause-related resources and medical care. Participants described that lifestyle and medical interventions for menopause in prison were inaccessible, and that untreated symptoms contributed to significant distress. Participants reported feeling as though medical staff did not believe their concerns and were dismissive of their complaints. In some cases, menopause symptoms and symptom management exacerbated the ways in which institutional barriers reproduce criminalization within the carceral system. CONCLUSIONS Individuals going through the menopause transition while experiencing incarceration have significant unmet needs and poor access to relieving lifestyle changes or medical interventions. Policy and practice changes should address menopause-related needs of individuals experiencing incarceration.
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Affiliation(s)
- Elana F. Jaffe
- Department of Maternal, Child, and Family Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill
- Center for Bioethics, Department of Social Medicine, University of North Carolina, Chapel Hill
| | - Aunchalee E. L. Palmquist
- Department of Maternal, Child, and Family Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Andrea K. Knittel
- Department of Obstetrics and Gynecology, Incarcerated Women’s Health Program, University of North Carolina, Chapel Hill
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Rohner E, Edelman C, Sanusi B, Schmitt JW, Baker A, Chesko K, Faherty B, Gregory SM, Romocki LS, Sivaraman V, Nelson JAE, O'Connor S, Hudgens MG, Knittel AK, Rahangdale L, Smith JS. Extended HPV Genotyping to Compare HPV Type Distribution in Self- and Provider-Collected Samples for Cervical Cancer Screening. Cancer Epidemiol Biomarkers Prev 2020; 29:2651-2661. [PMID: 32943435 DOI: 10.1158/1055-9965.epi-20-0674] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/06/2020] [Accepted: 09/10/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Primary high-risk human papillomavirus (hr-HPV) testing of self-collected cervico-vaginal swabs could increase cervical cancer screening coverage, although triage strategies are needed to reduce unnecessary colposcopies. We evaluated the use of extended hr-HPV genotyping of self-collected samples for cervical cancer screening. METHODS We recruited women ages 25-65 years at two colposcopy clinics in North Carolina between November 2016 and January 2019, and obtained self-collected cervico-vaginal samples, provider-collected cervical samples, and cervical biopsies from all enrolled women. Self- and provider-collected samples were tested for 14 hr-HPV genotypes using the Onclarity Assay (Becton Dickinson). We calculated hr-HPV genotype-specific prevalence and assessed agreement between results in self- and provider-collected samples. We ranked the hr-HPV genotypes according to their positive predictive value (PPV) for the detection of cervical intraepithelial neoplasia (CIN) grade 2 or higher (CIN2+). RESULTS A total of 314 women participated (median age, 36 years); 85 women (27%) had CIN2+. More women tested positive for any hr-HPV on self-collected (76%) than on provider-collected samples (70%; P = 0.009) with type-specific agreement ranging from substantial to almost perfect. HPV-16 was the most common genotype in self-collected (27%) and provider-collected samples (20%), and HPV-16 prevalence was higher in self- than provider-collected samples (P < 0.001). In self- and provider-collected samples, HPV-16 had the highest PPV for CIN2+ detection. CONCLUSIONS Overall sensitivity for CIN2+ detection was similar for both sample types, but the higher HPV-16 prevalence in self-collected samples could result in increased colposcopy referral rates. IMPACT Additional molecular markers might be helpful to improve the triage of women who are hr-HPV positive on self-collected samples.
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Affiliation(s)
- Eliane Rohner
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Claire Edelman
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina
| | - Busola Sanusi
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - John W Schmitt
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina
| | - Anna Baker
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | | | | | | | - LaHoma S Romocki
- Department of Public Health Education, North Carolina Central University, Durham, North Carolina
| | - Vijay Sivaraman
- Department of Biological and Biomedical Sciences, North Carolina Central University, Durham, North Carolina
| | - Julie A E Nelson
- Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Siobhan O'Connor
- Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Michael G Hudgens
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Andrea K Knittel
- Department of Obstetrics & Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Lisa Rahangdale
- Department of Obstetrics & Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Jennifer S Smith
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina. .,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
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24
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Knittel AK, Zarnick S, Thorp JM, Amos E, Jones HE. Medications for opioid use disorder in pregnancy in a state women's prison facility. Drug Alcohol Depend 2020; 214:108159. [PMID: 32683223 PMCID: PMC7977476 DOI: 10.1016/j.drugalcdep.2020.108159] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 06/16/2020] [Accepted: 06/21/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Medication for opioid use disorder (MOUD) improves both maternal and neonatal outcomes for pregnant women with opioid use disorder (OUD). Although correctional policies often state that incarcerated pregnant women with OUD should receive MOUD, implementation data is scant. Our aims were to 1) quantify the extent to which pregnant women in a Southeastern prison received MOUD during their incarceration; 2) to describe the medications and doses used during incarceration and frequency of MOUD referral after incarceration; and 3) identify associations between maternal characteristics and receipt of MOUD in order to identify points of intervention for clinical policy change. METHODS We conducted a retrospective chart review of pregnant women with OUD in a North Carolina state women's prison from 2016-2018. We collected MOUD, demographic, custody, pregnancy, and pre-incarceration substance use data. We used descriptive statistics, chi square tests, and logistic regression. RESULTS There were 179 pregnant women with OUD. During incarceration, 11.7 % received buprenorphine, 17.8 % methadone, 22.8 % oxycodone, and 47.8 % did not receive any opioid medications. Of those who received buprenorphine, methadone, and no MOUD, respectively, 65 %, 51.2 %, and 3.2 % were referred for community MOUD. Women were more likely to receive MOUD during incarceration if they had received MOUD pre-incarceration. CONCLUSIONS There was significant unmet need for MOUD and MOUD referral among pregnant women imprisoned in North Carolina from 2016-2018. Our findings suggest that the initial assessment for MOUD and referral to a community MOUD provider may represent opportunities to improve MOUD access for this population.
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Affiliation(s)
- Andrea K. Knittel
- Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | | | - John M. Thorp
- Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Elton Amos
- North Carolina Department of Public Safety, Raleigh, NC
| | - Hendree E. Jones
- UNC Horizons, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
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25
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Peart MS, Knittel AK. Contraception need and available services among incarcerated women in the United States: a systematic review. Contracept Reprod Med 2020; 5:2. [PMID: 32194976 PMCID: PMC7077150 DOI: 10.1186/s40834-020-00105-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 02/28/2020] [Indexed: 12/02/2022] Open
Abstract
Context Seventy-five percent of incarcerated women are of reproductive age, most of whom are at-risk for unintended pregnancy. Women who are incarcerated come disproportionately from socioeconomically disadvantaged backgrounds and often lack access to desired reproductive health care. While the carceral system provides a unique opportunity to fill this gap, a better understanding of the contraceptive needs, desires, and plans of incarcerated women is needed to optimize health care provision within the carceral system. A review of current contraceptive services available to women inmates may both identify model care programs and shed light on areas for improvement. Evidence acquisition PubMed electronic database used to identify relevant articles published between January 1975 and September 2019 using a systematic review method. Results Twenty-five articles met the inclusion criteria and answered four key questions surrounding contraception in the carceral system. Most articles (48%) represented scientific research. Other publications identified by this review were expert commentaries, policy briefings, guidance and recommendations reports, and law and bioethics reviews. Conclusions Incarcerated women desire access to standard and emergency contraception from carceral health care systems. Knowledgeable family planning practitioners providing patient-centered and trauma-informed care and public health interventions linking newly released inmates to community clinics can help alleviate inmates’ concerns regarding initiating desired contraception while incarcerated.
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Affiliation(s)
- Mishka S Peart
- 1Clinical Fellow in Complex Contraception and Family Planning, Division of Family Planning, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina USA
| | - Andrea K Knittel
- 2Division of General Obstetrics and Gynecology, University of North Carolina at Chapel Hill, 3027 Old Clinic Building, CB#7570, Chapel Hill, NC 27599-7570 USA
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26
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Rohner E, Rahangdale L, Sanusi B, Knittel AK, Vaughan L, Chesko K, Faherty B, Tulenko SE, Schmitt JW, Romocki LS, Sivaraman V, Nelson JAE, Smith JS. Test Accuracy of Human Papillomavirus in Urine for Detection of Cervical Intraepithelial Neoplasia. J Clin Microbiol 2020; 58:e01443-19. [PMID: 31896666 PMCID: PMC7041584 DOI: 10.1128/jcm.01443-19] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 12/12/2019] [Indexed: 01/22/2023] Open
Abstract
The objective was to assess the diagnostic test accuracy of high-risk human papillomavirus (hrHPV) testing of self-collected urine and cervicovaginal samples for the detection of cervical intraepithelial neoplasia grade 2 or higher (CIN2+). We recruited a convenience sample of women 25 to 65 years of age who were undergoing clinically indicated colposcopy at two medical centers in North Carolina between November 2016 and January 2019. Women with normal cytology results and positive hrHPV results were also recruited. Urine samples, self-collected cervicovaginal samples, provider-collected cervical samples, and cervical biopsy samples were obtained from all enrolled women. Samples were tested for hrHPV DNA using the Onclarity assay (Becton Dickinson, Sparks, MD). Biopsy samples were histologically graded as CIN2+ or
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Affiliation(s)
- Eliane Rohner
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lisa Rahangdale
- Department of Obstetrics and Gynecology, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Busola Sanusi
- Department of Biostatistics, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Andrea K Knittel
- Department of Obstetrics and Gynecology, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Kirsty Chesko
- Becton, Dickinson and Company, Sparks, Maryland, USA
| | - Brian Faherty
- Becton, Dickinson and Company, Sparks, Maryland, USA
| | - Samantha E Tulenko
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - John W Schmitt
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina, USA
| | - LaHoma S Romocki
- Department of Public Health Education, North Carolina Central University, Durham, North Carolina, USA
| | - Vijay Sivaraman
- Department of Biological and Biomedical Sciences, North Carolina Central University, Durham, North Carolina, USA
| | - Julie A E Nelson
- Department of Microbiology and Immunology, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jennifer S Smith
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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27
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Knittel AK, Shook-Sa BE, Rudolph J, Edmonds A, Ramirez C, Cohen M, Adedimeji A, Taylor T, Michel KG, Milam J, Cohen J, Donohue J, Foster A, Fischl M, Konkle-Parker D, Adimora AA. Incarceration and Number of Sexual Partners After Incarceration Among Vulnerable US Women, 2007-2017. Am J Public Health 2020; 110:S100-S108. [PMID: 31967873 PMCID: PMC6987934 DOI: 10.2105/ajph.2019.305410] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Objectives. To examine whether women's incarceration increases numbers of total and new sexual partners.Methods. US women with or at risk for HIV in a multicenter cohort study answered incarceration and sexual partner questions semiannually between 2007 and 2017. We used marginal structural models to compare total and new partners at visits not following incarceration with all visits following incarceration and visits immediately following incarceration. Covariates included demographics, HIV status, sex exchange, drug or alcohol use, and housing instability.Results. Of the 3180 participants, 155 were incarcerated. Women reported 2 partners, 3 or more partners, and new partners at 5.2%, 5.2%, and 9.3% of visits, respectively. Relative to visits not occurring after incarceration, odds ratios were 2.41 (95% confidence interval [CI] = 1.20, 4.85) for 2 partners, 2.03 (95% CI = 0.97, 4.26) for 3 or more partners, and 3.24 (95% CI = 1.69, 6.22) for new partners at visits immediately after incarceration. Odds ratios were similar for all visits following incarceration.Conclusions. Women had more total partners and new partners immediately and at all visits following incarceration after confounders and loss to follow-up had been taken into account.
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Affiliation(s)
- Andrea K. Knittel
- Andrea K. Knittel, Catalina Ramirez, and Adaora A. Adimora are with the School of Medicine, University of North Carolina, Chapel Hill. Bonnie E. Shook-Sa, Jacqueline Rudolph, and Andrew Edmonds are with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Mardge Cohen is with Stroger Hospital, Chicago, IL. Adebola Adedimeji is with the Albert Einstein College of Medicine, Bronx, NY. Tonya Taylor is with the SUNY Downstate Medical Center, Brooklyn, NY. Katherine G
| | - Bonnie E. Shook-Sa
- Andrea K. Knittel, Catalina Ramirez, and Adaora A. Adimora are with the School of Medicine, University of North Carolina, Chapel Hill. Bonnie E. Shook-Sa, Jacqueline Rudolph, and Andrew Edmonds are with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Mardge Cohen is with Stroger Hospital, Chicago, IL. Adebola Adedimeji is with the Albert Einstein College of Medicine, Bronx, NY. Tonya Taylor is with the SUNY Downstate Medical Center, Brooklyn, NY. Katherine G
| | - Jacqueline Rudolph
- Andrea K. Knittel, Catalina Ramirez, and Adaora A. Adimora are with the School of Medicine, University of North Carolina, Chapel Hill. Bonnie E. Shook-Sa, Jacqueline Rudolph, and Andrew Edmonds are with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Mardge Cohen is with Stroger Hospital, Chicago, IL. Adebola Adedimeji is with the Albert Einstein College of Medicine, Bronx, NY. Tonya Taylor is with the SUNY Downstate Medical Center, Brooklyn, NY. Katherine G
| | - Andrew Edmonds
- Andrea K. Knittel, Catalina Ramirez, and Adaora A. Adimora are with the School of Medicine, University of North Carolina, Chapel Hill. Bonnie E. Shook-Sa, Jacqueline Rudolph, and Andrew Edmonds are with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Mardge Cohen is with Stroger Hospital, Chicago, IL. Adebola Adedimeji is with the Albert Einstein College of Medicine, Bronx, NY. Tonya Taylor is with the SUNY Downstate Medical Center, Brooklyn, NY. Katherine G
| | - Catalina Ramirez
- Andrea K. Knittel, Catalina Ramirez, and Adaora A. Adimora are with the School of Medicine, University of North Carolina, Chapel Hill. Bonnie E. Shook-Sa, Jacqueline Rudolph, and Andrew Edmonds are with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Mardge Cohen is with Stroger Hospital, Chicago, IL. Adebola Adedimeji is with the Albert Einstein College of Medicine, Bronx, NY. Tonya Taylor is with the SUNY Downstate Medical Center, Brooklyn, NY. Katherine G
| | - Mardge Cohen
- Andrea K. Knittel, Catalina Ramirez, and Adaora A. Adimora are with the School of Medicine, University of North Carolina, Chapel Hill. Bonnie E. Shook-Sa, Jacqueline Rudolph, and Andrew Edmonds are with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Mardge Cohen is with Stroger Hospital, Chicago, IL. Adebola Adedimeji is with the Albert Einstein College of Medicine, Bronx, NY. Tonya Taylor is with the SUNY Downstate Medical Center, Brooklyn, NY. Katherine G
| | - Adebola Adedimeji
- Andrea K. Knittel, Catalina Ramirez, and Adaora A. Adimora are with the School of Medicine, University of North Carolina, Chapel Hill. Bonnie E. Shook-Sa, Jacqueline Rudolph, and Andrew Edmonds are with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Mardge Cohen is with Stroger Hospital, Chicago, IL. Adebola Adedimeji is with the Albert Einstein College of Medicine, Bronx, NY. Tonya Taylor is with the SUNY Downstate Medical Center, Brooklyn, NY. Katherine G
| | - Tonya Taylor
- Andrea K. Knittel, Catalina Ramirez, and Adaora A. Adimora are with the School of Medicine, University of North Carolina, Chapel Hill. Bonnie E. Shook-Sa, Jacqueline Rudolph, and Andrew Edmonds are with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Mardge Cohen is with Stroger Hospital, Chicago, IL. Adebola Adedimeji is with the Albert Einstein College of Medicine, Bronx, NY. Tonya Taylor is with the SUNY Downstate Medical Center, Brooklyn, NY. Katherine G
| | - Katherine G. Michel
- Andrea K. Knittel, Catalina Ramirez, and Adaora A. Adimora are with the School of Medicine, University of North Carolina, Chapel Hill. Bonnie E. Shook-Sa, Jacqueline Rudolph, and Andrew Edmonds are with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Mardge Cohen is with Stroger Hospital, Chicago, IL. Adebola Adedimeji is with the Albert Einstein College of Medicine, Bronx, NY. Tonya Taylor is with the SUNY Downstate Medical Center, Brooklyn, NY. Katherine G
| | - Joel Milam
- Andrea K. Knittel, Catalina Ramirez, and Adaora A. Adimora are with the School of Medicine, University of North Carolina, Chapel Hill. Bonnie E. Shook-Sa, Jacqueline Rudolph, and Andrew Edmonds are with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Mardge Cohen is with Stroger Hospital, Chicago, IL. Adebola Adedimeji is with the Albert Einstein College of Medicine, Bronx, NY. Tonya Taylor is with the SUNY Downstate Medical Center, Brooklyn, NY. Katherine G
| | - Jennifer Cohen
- Andrea K. Knittel, Catalina Ramirez, and Adaora A. Adimora are with the School of Medicine, University of North Carolina, Chapel Hill. Bonnie E. Shook-Sa, Jacqueline Rudolph, and Andrew Edmonds are with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Mardge Cohen is with Stroger Hospital, Chicago, IL. Adebola Adedimeji is with the Albert Einstein College of Medicine, Bronx, NY. Tonya Taylor is with the SUNY Downstate Medical Center, Brooklyn, NY. Katherine G
| | - Jessica Donohue
- Andrea K. Knittel, Catalina Ramirez, and Adaora A. Adimora are with the School of Medicine, University of North Carolina, Chapel Hill. Bonnie E. Shook-Sa, Jacqueline Rudolph, and Andrew Edmonds are with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Mardge Cohen is with Stroger Hospital, Chicago, IL. Adebola Adedimeji is with the Albert Einstein College of Medicine, Bronx, NY. Tonya Taylor is with the SUNY Downstate Medical Center, Brooklyn, NY. Katherine G
| | - Antonina Foster
- Andrea K. Knittel, Catalina Ramirez, and Adaora A. Adimora are with the School of Medicine, University of North Carolina, Chapel Hill. Bonnie E. Shook-Sa, Jacqueline Rudolph, and Andrew Edmonds are with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Mardge Cohen is with Stroger Hospital, Chicago, IL. Adebola Adedimeji is with the Albert Einstein College of Medicine, Bronx, NY. Tonya Taylor is with the SUNY Downstate Medical Center, Brooklyn, NY. Katherine G
| | - Margaret Fischl
- Andrea K. Knittel, Catalina Ramirez, and Adaora A. Adimora are with the School of Medicine, University of North Carolina, Chapel Hill. Bonnie E. Shook-Sa, Jacqueline Rudolph, and Andrew Edmonds are with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Mardge Cohen is with Stroger Hospital, Chicago, IL. Adebola Adedimeji is with the Albert Einstein College of Medicine, Bronx, NY. Tonya Taylor is with the SUNY Downstate Medical Center, Brooklyn, NY. Katherine G
| | - Deborah Konkle-Parker
- Andrea K. Knittel, Catalina Ramirez, and Adaora A. Adimora are with the School of Medicine, University of North Carolina, Chapel Hill. Bonnie E. Shook-Sa, Jacqueline Rudolph, and Andrew Edmonds are with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Mardge Cohen is with Stroger Hospital, Chicago, IL. Adebola Adedimeji is with the Albert Einstein College of Medicine, Bronx, NY. Tonya Taylor is with the SUNY Downstate Medical Center, Brooklyn, NY. Katherine G
| | - Adaora A. Adimora
- Andrea K. Knittel, Catalina Ramirez, and Adaora A. Adimora are with the School of Medicine, University of North Carolina, Chapel Hill. Bonnie E. Shook-Sa, Jacqueline Rudolph, and Andrew Edmonds are with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Mardge Cohen is with Stroger Hospital, Chicago, IL. Adebola Adedimeji is with the Albert Einstein College of Medicine, Bronx, NY. Tonya Taylor is with the SUNY Downstate Medical Center, Brooklyn, NY. Katherine G
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Abstract
Criminal justice system involvement among US women is associated with increased risk for HIV/sexually transmitted infections, yet effects of different forms of criminal justice involvement on intimate relationships are not well understood. This study examined associations between arrest, probation, and jail incarceration on the number of sexual partners, sexual concurrency, and consistent condom use for drug-using women (n = 631) in Oakland, California. We used logistic and negative binomial regression and adjusted for demographics, sex exchange and drug use. Probation was associated with higher rates of sexual partnership and concurrency (IRR 1.87, 95% CI [1.11, 3.15]; OR 3.64, 95% CI [1.08, 12.20]). Incarceration lasting over 12 weeks was associated with higher rates of sexual partnership (IRR 2.23, 95% CI [1.41, 3.51]). Women incarcerated once in the past year had higher odds of concurrency (OR 2.15, 95% CI [1.01, 4.57]). Our results reinforce the need for risk-reduction interventions and criminal justice diversion for women who use drugs.
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Affiliation(s)
- Andrea K Knittel
- Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of North Carolina, 3031 Old Clinic Building/CB #7570, Chapel Hill, NC, 27599-7570, USA.
| | - Barrot H Lambdin
- Division of Behavioral Health and Criminal Justice, RTI International, San Francisco, CA, USA
| | - Megan L Comfort
- Division of Behavioral Health and Criminal Justice, RTI International, San Francisco, CA, USA
| | - Alex H Kral
- Division of Behavioral Health and Criminal Justice, RTI International, San Francisco, CA, USA
| | - Jennifer Lorvick
- Community Health and Implementation Research Program, RTI International, San Francisco, CA, USA
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Lee F, Zahn K, Knittel AK, Morse J, Louie M. Laparoscopic hysterectomy to manage uterine rupture due to placenta percreta in the first trimester: A case report. Case Rep Womens Health 2019; 25:e00165. [PMID: 31886137 PMCID: PMC6920503 DOI: 10.1016/j.crwh.2019.e00165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 11/23/2019] [Accepted: 11/26/2019] [Indexed: 11/26/2022] Open
Abstract
Placenta percreta causing uterine rupture is a rare complication of pregnancy. It is most commonly diagnosed after the second trimester and can lead to significant morbidity necessitating abdominal hysterectomy of a gravid or immediately postpartum uterus. We describe a patient who presented with abdominal pain at 13 weeks of gestation and was diagnosed with placenta percreta during laparoscopy for presumed appendicitis. Intraoperatively, placenta was seen perforating the uterine fundus and 1 l of hemoperitoneum was evacuated. However, the uterus was hemostatic and the patient was stable, so the procedure was terminated. The patient was then transferred to a tertiary care center, where she ultimately underwent an uncomplicated laparoscopic gravid hysterectomy. We conclude that placenta percreta can occur in the first trimester even in patients without traditional risk factors. In stable patients, it is appropriate to consider minimally invasive hysterectomy with utilization of specific techniques to minimize intraoperative blood loss. Uterine rupture due to placenta percreta can present in the first trimester. Minimally invasive laparoscopic hysterectomy can provide definitive treatment with decreased surgical morbidity and shorter convalescence. Blood loss and allogenic transfusion can be minimized with appropriate hemostatic techniques and surgical planning.
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Affiliation(s)
- Fan Lee
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, United States of America
| | - Katelin Zahn
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, United States of America
| | - Andrea K Knittel
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, United States of America.,Division of Generalist Obstetrics and Gynecology, United States of America
| | - Jessica Morse
- Division of Family Planning, United States of America
| | - Michelle Louie
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, United States of America.,Division of Minimally Invasive Gynecological Surgery, United States of America
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Abstract
Women who are involved in the criminal justice system experience poorer reproductive health outcomes. Resolving this inequality will require addressing reproductive health disparities facing incarcerated women, improving the health of criminal justice-involved women in the community, and preventing engagement of women with the criminal justice system altogether.
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Affiliation(s)
- Andrea K Knittel
- assistant professor, Division of General Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Knittel AK, Lorvick J. Self-reported sexually-transmitted infections and criminal justice involvement among women who use drugs. Addict Behav Rep 2019; 10:100219. [PMID: 31692579 PMCID: PMC6806366 DOI: 10.1016/j.abrep.2019.100219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 08/14/2019] [Accepted: 09/08/2019] [Indexed: 01/29/2023] Open
Abstract
Background Women involved in the criminal justice system in the United States have high rates of sexually transmitted infections (STI). It is unknown whether criminal justice involvement is a marker for other risk behavior, such as sex exchange or drug use, or criminal justice involvement itself increases risk directly. Methods This study examines the relationship between STI and the frequency and duration of arrest, probation, and incarceration in a sample of women who use drugs (n = 394) in Oakland, California who reported having been tested for STI in the past six months. Logistic regression models of STI using criminal justice measures as independent variables were used, and subsequent estimates were adjusted for demographics, sex exchange, specific drugs used, and number of sexual partners. Results Any time spent in jail in the past year was associated with higher odds of recent STI (UOR = 2.28, 95%CI [1.41–3.51]), and short incarcerations (2–3 weeks) in jail most substantially increased the odds of an STI diagnosis (UOR = 7.65, 95%CI [1.03, 56.68]). Arrest and probation were not significantly associated with STI. After adjusting for the covariates, particularly sex exchange and opioid use, none of the criminal justice-related variables were significantly associated with STI. Conclusions A substantial portion of the increased risk of STI that is associated with criminal justice involvement for women who use drugs is likely due to sex exchange. Longitudinal studies are needed to temporally separate criminal justice exposures, drug use, sex exchange, and STI outcomes. Criminal justice involvement is common for women who use drugs. Short jail incarcerations (2–3 weeks) were associated with an increased odds of STI, largely accounted for by sex exchange and opioid use. Qualitative studies that examine why women's sexual partnerships, opioid use, and sex exchange change after incarceration are needed.
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Affiliation(s)
- Andrea K Knittel
- Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, United States of America
| | - Jennifer Lorvick
- Urban Health Program, RTI International, San Francisco, CA, United States of America
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Abstract
Within the related epidemics of sex exchange, drug use, and poverty, access to health care is shaped by intersecting identities, policy, and infrastructure. This study uses a unique survey sample of young adults in Detroit, who are exchanging sex on the street, in strip clubs, and at after-hours parties and other social clubs. Factors predicting access to free or affordable health care services, such as venue, patterns of sexual exchange influence, drug use and access to transportation, were examined using multivariable logistic regression and qualitative comparative analysis. The most significant predictors of low access to health care services were unstable housing and lack of access to reliable transportation. In addition, working on the street was associated with decreased access to services. Coordinated policy and programming changes are needed to increase health care access to this group, including improved access to transportation, housing, and employment, and integration of health care services.
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Affiliation(s)
- Andrea K Knittel
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA. .,Division of General Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA.
| | - Louis F Graham
- Department of Community Health Education, School of Public Health and HealthSciences, University of Massachusetts, Amherst, MA, USA
| | | | - William Lopez
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | - Rachel C Snow
- Population and Development Branch, United Nations Population Fund (UNFPA), NewYork, NY, USA
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Abstract
For young adult sex workers, the risk of arrest and incarceration are dramatically influenced by the venue of sex exchange and individual and neighborhood characteristics. Using a unique venue-based survey sample of young adults in Detroit who are exchanging sex, multivariable logistic regression models were used to identify associations with arrest and incarceration. Criminal justice involvement was normative, and risk was increased by working on the street venue, using drugs, lacking stable housing, juvenile arrest or incarceration, dropping out of school before age 18, and neighborhood characteristics. Several promising points of intervention could reduce criminal justice involvement for young adults exchanging sex.
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Affiliation(s)
- Andrea K. Knittel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109-2029 USA
| | - Louis F. Graham
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109-2029 USA
| | - William Lopez
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109-2029 USA
| | - Rachel C. Snow
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109-2029 USA
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Knittel AK, Snow RC, Riolo RL, Griffith DM, Morenoff J. Modeling the community-level effects of male incarceration on the sexual partnerships of men and women. Soc Sci Med 2015; 147:270-9. [PMID: 26610077 PMCID: PMC4691451 DOI: 10.1016/j.socscimed.2015.11.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 10/23/2015] [Accepted: 11/05/2015] [Indexed: 11/24/2022]
Abstract
Men who have been incarcerated experience substantial changes in their sexual behavior after release from jail and prison, and high rates of incarceration may change sexual relationship patterns at a community level. Few studies, however, address how rates of incarceration affect community patterns of sexual behavior, and the implications of those patterns for HIV and STD risk. We describe a "proof of principle" computational model that tests whether rates of male incarceration could, in part, explain observed population-level differences in patterns of sexual behavior between communities with high rates of incarceration and those without. This validated agent-based model of sexual partnership among 20-25 year old heterosexual urban residents in the United States uses an algorithm that incarcerates male agents and then releases them back into the agent community. The results from these model experiments suggest that at rates of incarceration similar to those observed for urban African American men, incarceration can cause an increase in the number of partners at the community level. The results suggest that reducing incarceration and creating a more open criminal justice system that supports the maintenance of inmates' relationships to reduce instability of partnerships for men who are incarcerated may have important sexual health and public health implications. Incarceration is one of many social forces that affect sexual decision-making, and incarceration rates may have substantial effects on community-level HIV and STD risks.
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Affiliation(s)
- Andrea K Knittel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA; University of Michigan Medical School, 1137 Catherine Street, Ann Arbor, MI 48109, USA.
| | - Rachel C Snow
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
| | - Rick L Riolo
- Center for the Study of Complex Systems, University of Michigan, 1085 S. University Ave., Ann Arbor, MI 48109, USA.
| | - Derek M Griffith
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
| | - Jeffrey Morenoff
- Department of Sociology, University of Michigan, 500 S State St #3001, Ann Arbor, MI 48109, USA.
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Abstract
The agent-based model presented here builds on existing models, allowing for multiple partnerships, including those overlapping in time, to examine sexual partnerships, with the goal of hypothesis testing and guiding data collection. Within each model run, agents are assigned characteristics (including quality, aspiration, courtship duration, and ideal number of lifetime partners) and then search for partners; existing couples choose whether they should break up, remain dating, or become sexual partners. Model behavior was tested across a wide range of parameters and compared with empirical data. The model produces numbers of lifetime sexual partners, and partners in the last year, rates of concurrency, and relationship durations similar to nationally representative data from the US; it also generates correlations in partners' quality similar to those reported for marriage and dating partners. Model results highlight the importance of individual preferences, interactions between individuals, and contextual factors in sexual decision-making.
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Affiliation(s)
- Andrea K Knittel
- University of Michigan School of Public Health, Department of Health Behavior and Health Education
| | - Rick L Riolo
- University of Michigan, Center for the Study of Complex Systems
| | - Rachel C Snow
- University of Michigan School of Public Health, Department of Health Behavior and Health Education
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Abstract
Background Injection drug users continue to be at high risk of HIV and HCV. Research has shown that needle exchange programs (NEP) decrease injection frequency, reduce syringe reuse, and reduce needle sharing, though some results have been mixed. Methods This evaluation of a small, peri-urban, legal NEP near Ypsilanti, Michigan describes the operation of the NEP and its clients. It uses interviews conducted with NEP participants between 2003 and 2006, describing the population served by the program, and draws on limited comparisons between matched baseline and follow-up measures as well as aggregate baseline and follow-up comparisons. Results The HIV/AIDS Resource Center (HARC) Harm Reduction NEP serves a diverse population from a wide geographical area. NEP participants at follow-up reused their syringes significantly fewer times before getting new ones, were significantly less likely to report giving another IDU a previously used syringe, and were more likely to clean their skin with alcohol either before or after injecting than the baseline comparison group. Conclusions The limited data presented here suggest that a NEP can be an effective method of harm reduction even in low-volume, non-urban settings and are an important venue for intervention in peri-urban areas.
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Affiliation(s)
- Andrea K Knittel
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
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Booth EA, Marchesi M, Knittel AK, Kilbourne EJ, Lucchesi BR. The Pathway-Selective Estrogen Receptor Ligand WAY-169916 Reduces Infarct Size After Myocardial Ischemia and Reperfusion by an Estrogen Receptor Dependent Mechanism. J Cardiovasc Pharmacol 2007; 49:401-7. [PMID: 17577105 DOI: 10.1097/fjc.0b013e3180544527] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Previous studies have shown that estrogen treatment protects the heart from reperfusion injury. The adverse effects of long-term estrogen treatment limit its clinical use and emphasize the need for the development of specific pharmacological interventions such as pathway-selective estrogen receptor (ER) ligands. Pathway-selective ER ligands are compounds that retain estrogen's anti-inflammatory ability, but they are devoid of conventional estrogenic action. In the present study, the pathway-selective ER ligand WAY-169916 was assessed for its cardioprotective potential in an in vivo model of ischemia-reperfusion injury. Anesthetized, ovariectomized rabbits were administered WAY-169916 (1 mg/kg), 17beta-estradiol (E2; 20 microg/rabbit), or vehicle intravenously 30 minutes before a 30-minute occlusion and 4 hours of reperfusion. Acute treatment with either WAY-169916 or E2 resulted in a decrease in infarct size, expressed as a percent of area at risk (WAY-169916, 21.2 +/- 3.3; P < 0.001 and E2, 18.8 +/- 1.7; P < 0.001) compared with vehicle 59.4 +/- 5.4). Pretreatment with estrogen receptor antagonist ICI 182,780 significantly limited the infarct size sparing effect of both WAY-169916 and E2 when expressed as a percent of the risk region (WAY 169916, 47.4 +/- 4.4; E2, 53.01 +/- 5.0). The results demonstrate that WAY-169916 protects the heart against ischemia-reperfusion injury through an ER-dependent mechanism.
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Affiliation(s)
- Erin A Booth
- Department of Pharmacology, University of Michigan Medical School, Ann Arbor, Michigan 48109-0632, USA.
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