Exploring African-American and Latino Teens' Perceptions of Contraception and Access to Reproductive Health Care Services

PURPOSE

Reducing disparities in teen pregnancy and birth rates among African American and Latina teens is a central focus of a community-wide teen pregnancy prevention initiative implemented by the South Carolina Campaign to Prevent Teen Pregnancy. Disparities in teen pregnancy and birth rates are driven, in part, by differential access to contraception and reproductive health care services. The purpose of this qualitative study was to understand African American and Latino teens' 1) preferences for finding health information, 2) perceptions of accessing reproductive health services, and 3) beliefs about contraception.

METHODS

As a part of this community-wide initiative, eight focus groups were conducted in the Fall of 2012 with African American and Latino male and female youth from two communities in South Carolina. Among eight focus groups of youth, teens most often reported parents, other trusted relatives, and the Internet as sources of health information.

RESULTS

Participants discussed the value of social media and television advertisements for reaching young people and emphasized the importance of privacy, a desire for a teen-only clinic, and the need for friendly clinical staff. Participants' comments often reflected inaccurate beliefs about the reliability and correct usage of contraceptive methods. Female participants also reported side effects of birth control as a potential barrier to use.

CONCLUSIONS

Ensuring that teens' beliefs and perceptions are taken into account when developing, marketing, and implementing culturally competent reproductive health care services is important to improve access to care for all teens in Horry and Spartanburg Counties.

Enhancing teen pregnancy prevention in local communities: capacity building using the interactive systems framework

Getting To Outcomes (GTO), an innovative framework for planning, implementing, evaluating, and sustaining interventions has been shown to be effective in helping community-based organizations (CBOs) introduce science-based approaches into their prevention work. However, the Interactive Systems Framework (ISF) suggests that adopting innovations like GTO requires a significant amount of capacity building through training and technical assistance (T/TA). In this study, 11 CBOs and three schools in South Carolina entered into a 3 year program of intense and proactive T/TA based on the ISF to learn how to apply an adaptation of GTO (Promoting Science-Based Approaches-Getting To Outcomes, PSBA-GTO) to their teen pregnancy prevention programs. Using semi-structured interviews, the partnering organizations were assessed at three points in time, pre-T/TA, 12 months, and post T/TA (30 months) for their performance of the steps of GTO in their work. The seven organizations which participated in T/TA until the end of the project received an average of 76 h of TA and 112 h of training per organization. Interview results showed increased performance of all 10 steps of PSBA-GTO by these organizations when conducting their teen pregnancy programs. These results suggest targeted and proactive T/TA can successfully bridge the gap between research and practice by using a three part delivery system, as prescribed in the ISF, which relies on an intermediary prevention support system to ensure accurate and effective translation of research to the everyday work of community-based practitioners.

Promoting science-based approaches to teen pregnancy prevention: proactively engaging the three systems of the interactive systems framework

In the field of teen pregnancy prevention many efficacious prevention programs are available but adoption of these programs is slow at the community level. In this article, we present a multi-site, capacity-building effort called the Promoting Science-based Approaches to Teen Pregnancy Prevention project (PSBA) as a case example of a proactive application of the Interactive System Framework (ISF) for dissemination and implementation. The ISF is a multi-system model leading to dissemination and implementation of science-based prevention programming through the work of three interactive systems: The "Prevention Delivery," "Prevention Support," and "Prevention Synthesis & Translation" Systems. This article describes the proactive use of the ISF to conceptualize and bolster the PSBA program's goal of assisting local prevention partners in the use of science-based approaches (SBA) to prevent teen pregnancy. PSBA uses all three systems of the ISF to facilitate practice improvements and offers valuable research opportunities to investigate factors related to dissemination and implementation processes across these systems. Describing our application of this framework highlights the feasibility of actively using the ISF to build prevention infrastructure and to guide large-scale prevention promotion strategies in the area of teen pregnancy prevention. The program's ongoing evaluation is presented as an example of early efforts to develop an evidence base around the ISF. Research implications are discussed.

Fibrillary renal deposits and nephritis

Fibrillary renal deposits and nephritis. The authors have studied 8 patients whose glomeruli contain abundant fibrils in their mesangial matrix and basement membranes. Although the location of these fibrils is very similar to that of amyloid, they are about twice the size of amyloid fibrils, averaging 20 nm in width, and fail to react as amyloid does with special stains. Immunofluorescence-microscopic studies are usually positive with antiserums to IgG, often IgM, and in some cases IgA, and also kappa and lambda light chains, C3, and C4. The fibrils are associated with diffuse mesangial widening and increased mesangial matrix strands. Although peripheral glomerular capillary walls appear to be spared initially, their eventual involvement leads to glomerular capillary collapse and glomerular obsolescence. Crescent formation occurred in 5 cases, focally in 3 and diffusely in 2. Tubular basement membrane involvement was seen in 1 case. These patients exhibit hematuria, and proteinuria, and often hypertension and renal insufficiency. Proteinuria was in the nephrotic range in 3 patients in whom involvement of glomerular capillary basement membranes was extensive. Unless electron microscopy is applied to renal biopsies, these cases may be considered to represent mesangiocapillary or rapidly progressive glomerulonephritis, or amyloidosis. The nature of these fibrils is as yet not determined. It is likely that they have been called "atypical amyloidosis" in the past.

Glomerular zippers and ports?

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Identification of dense deposit disease: a report for the International Study of Kidney Diseases in Children

The fluorescent dye thioflavin T stains intensely the deposits in dense deposit disease and can be used for identification purposes. Comparison of thioflavin T staining with electron microscopy was carried out in 25 patients and showed excellent congruity. Thioflavin T is much easier to use, but is less specific than electron microscopy. Cases of light chain disease and of some gammopathies can be a source of confusion. In nearly all other instances, the pattern of staining helps to differentiate dense deposits from other types of deposits and from amyloid.

Mesangial involvement in hemolytic-uremic syndrome. A light and electron microscopic study

Electron microscopic analysis of the mesangial injury in the hemolytic-uremic syndrome was performed in 10 patients. Proteinaceous material similar to that found in the subendothelial region was also seen focally in the mesangium altering the matrix and imparting a reticular appearance. This degenerative process was associated with reparative changes in the glomerular tuft. Many of the mesangial cells were hypertrophied and demonstrated phagocytic activity and peripheral extension of their cytoplasmic processes. Mitotic figures in endothelial as well as mesangial cells were regarded as evidence of a reparative process. Severe mesangial insudation of material containing fibrinogen derivatives resulted in segmental tuft necrosis with almost complete replacement and destruction of the mesangial matrix. On some occasions, a break of the glomerular basement membrane was accompanied by the escape of intraluminal contents into the urinary space, leading to crescentic epithelial cell proliferation.

Ultrastructural alterations in livers with metastasis

The electron microscopic examination of 13 biopsy specimens of livers that contained metastatic carcinoma revealed degenerative alterations of the mitochondria, cystic dilatation of the endoplasmic reticulum, increased amounts of osmiophilic material, some in various stages of autophagocytosis, and lipid vacuoles within the hepatocytes. In ten of 13 cases, the hepatocytes demonstrated mitochondrial paracrystalline inclusions. The observation of the latter structures in edematous hepatocytes containing phospholipid-rich osmiophilic deposits tends to confirm the experimental hypothesis that paracrystalline inclusions are caused by the precipitation of unmasked phospholipids. The spectrum of ultrastructural findings suggests hypoxia and impaired lipid metabolism of the hepatic tissue as a result of congestion and bile stasis caused by the tumor nodules.

Microcirculation in diabetes mellitus: a study of gingival biopsies

Gingival biopsy specimens from 24 diabetic patients, six obese persons, and six controls were studied statistically and morphologically to detect vascular basement membrane changes using a proposed classification of microvessels. Statistically significant basement membrane thickening is seen in all diabetic groups in most true capillaries and vessels proximal to them, especially in terminal arterioles and metarterioles, although the degree and extent of the changes vary among different clinical groups and vessel types. The basement membrane thickening is characterized by increased amorphous, granular, and fibrillary material with occasional scattered collagenous fibrils. Although nonspecific, basement membrane thickening in microvessels at, and especially proximal to, the level of true capillaries is intimately related to diabetes. Gingival biopsy may possibly be used as an adjunct in the diagnosis of diabetes.

Morphological and biological characteristics of the M-P strain of lymphocytic choriomeningitis virus

Based on present data, the M-P virus appears antigenically and morphologically to be a strain of the lymphocytic choriomeningitis virus, with some different biological properties.

Intraglomerular fibrin, platelet aggregation, and subendothelial deposits in lipoid nephrosis

We have investigated the formation of fibrin, platelet aggregates, and subendothelial deposits in lipoid nephrosis. Fibrin formation was found in 10 cases of active lipoid nephrosis. Platelet aggregates were found in eight cases and subendothelial deposits in nine. Fibrin and platelets were also found in cases of nephrotic syndrome due to other causes, and in glomerulonephritis. Fibrin was generally absent in lipoid nephrosis in remission and in benign recurrent hematuria. It is suggested that what seems to be a lower incidence in females is more apparent than real and that fibrin or related material may be present in a less easily identifiable form. Steroid therapy apparently had no effect on the presence or absence of fibrin. Most instances were associated with elevated serum cholesterol and alpha(2)-globulin. It is suggested that elevated serum lipids as well as the disease process in the kidney play a role in this phenomenon. It is further suggested that intraglomerular fibrin formation could lead to irreversible renal damage in lipoid nephrosis.

Ciliated human renal proximal tubular cells. Observations in three cases of hypercalcemia

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