Background Similar to broader health disparities, Latinx adolescents have higher rates of high-risk sexual behavior resulting in pregnancy rates that are 2 times higher and sexually transmitted infection rates that are 5 to 8 times higher than non-Hispanic, white adolescents. Novel approaches are needed to reduce high-risk sexual behavior among Spanish-speaking Latinx adolescents who represent the fastest-growing group of US immigrants. Objective This study aimed to partner with Spanish-speaking Latinx adolescents in a participatory design process to develop and test a Spanish-language video game intervention to decrease high-risk heterosexual behavior. Methods This is an iterative, two-phase, mixed methods study. In phase 1, we conducted focus groups with Spanish-speaking Latinx adolescents to elicit feedback on the content and format of an existing English-language video game. Feedback was then incorporated into an expanded and culturally adapted Spanish-language video game. In phase 2, we pilot tested the feasibility, acceptability, and preliminary efficacy of the new Spanish-language video game intervention by measuring known antecedents to sexual behavior (intentions, self-efficacy, risk perception, and knowledge) assessed at enrollment and 12-week follow-up. We applied a thematic analysis to examine focus group feedback and a bivariate analysis to analyze pre- and postquantitative data. Results In phase 1, 15 Spanish-speaking Latinx adolescents provided feedback for further video game development. A Spanish-language video game was then produced and tested in phase 2. We recruited and enrolled 24 Spanish-speaking Latinx adolescents aged 15 to 17 years. Participants played the video game for an average of 4.2 hours during monitored sessions. Pilot testing demonstrated feasibility and acceptability; 65% (3/20) of participants stated that they would play it again, and 65% (3/20) said they would recommend it to friends. Condom-specific knowledge did significantly increase between baseline and follow-up (P=.007). Other variables of sexual behavior antecedents did not differ significantly between baseline and 12-week follow-up. Conclusions An iterative participatory design process in partnership with Spanish-speaking adolescents produced an innovative and acceptable Spanish-language video game intervention aimed at decreasing high-risk sexual behavior in adolescents. Pilot testing demonstrated preliminary feasibility and yielded essential information for further video game development.

Background: To evaluate the relationship between periconceptional (period before and/or after conception) substance use and unfavorable pregnancy contexts, including unintended pregnancy. Materials and Methods: This is a cross-sectional analysis of English-or Spanish-speaking women aged 16-44 years with pregnancies <24 weeks' gestation presenting to pregnancy testing clinics and enrolled between June 2014 and June 2015. Participants self-reported periconceptional substance use (tobacco, alcohol, marijuana, and other illicit substances during the 3 months before enrollment), and pregnancy ''contexts,'' including pregnancy intention, wantedness, planning, timing, desirability, and happiness. Multivariable logistic regression was performed adjusting for potential confounding variables. Results: We enrolled 123 women, averaging 27 -6 years, and mean gestational age 7.5 -3.0 weeks. Most participants were black, non-Hispanic (37%), or Hispanic (46%), and chose to complete the study in English (69%). Sixty-five percent participants reported use of one or more substances during prior 3 months: alcohol (54%), tobacco (31%), and marijuana (21%). In multivariate analysis, periconceptional alcohol use was associated with increased odds of unintended or ambivalent pregnancy and unwanted or mixed feelings regarding pregnancy (odds ratios [OR] = 3.29, 95% confidence interval [CI] 1.08-10.08 and OR = 2.81, 95% CI 1.07-7.36, respectively). Weekly or daily tobacco use was associated with unhappiness about pregnancy (OR = 7.56, 95% CI 1.65-34.51) and undesired or unsure pregnancy (OR = 4.00, 95% CI 1.14-14.06). Conclusions: Periconceptional alcohol or tobacco use demonstrates increased odds of specific unfavorable pregnancy contexts, including pregnancy described as undesired, unintended, unwanted, and unhappiness with pregnancy. Primary prevention of periconceptional substance use and the negative effects of alcohol and tobacco may be improved by increasing contraception access for women at risk for unfavorable pregnancy contexts.Keywords: alcohol; pregnancy; tobacco; unintended pregnancy; unplanned pregnancy However, focusing on preconception care in this way may be insufficient as it assumes that women have control over their reproductive lives, that contraception never fails, that all pregnancies are planned, and that such assumptions are inherently flawed. 5,6 For example, purposeful abstinence regarding tobacco, alcohol,

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Previous research assessed the impact of state regulations on clinics and patients, but how bureaucrats implement them is less understood and increasingly important as states arbitrate abortion regulation. We conducted a case study of how bureaucrats use discretion to implement state regulations on abortion, focusing on two abortion facilities in Southwest Ohio from 2010-2022. Ohio abortion facilities are required to obtain a written transfer agreement, despite it offering no demonstrable health or safety benefits. We find that state requirements for obtaining variances, a process that allows abortion facilities to operate without a written transfer agreement, have become exceedingly difficult to comply with. We show how state statutes and administrative law enabled bureaucrats to wield unlimited discretion and enforce arbitrary requirements. This unlimited bureaucratic discretion and accompanying administrative burden exacerbated clinic instability and threatened abortion availability in Southwest Ohio for almost a decade. As implementation and interpretation of abortion policy is increasingly left to state bureaucrats and civil servants following the Supreme Court’s Dobbs decision, how bureaucrats use discretion will influence clinic stability and abortion availability. We posit that unlimited bureaucratic discretion may exert greater influence on abortion availability across the nation as states scramble to clarify and implement policies post-Dobbs.

INTRODUCTION: Assess the effect of immediate access to postpartum (PP) LARCs (long-acting reversible contraceptives) and contraceptive access through Medicaid expansion (ME) on short interpregnancy interval (IPI) rates in the US. METHODS: Population-based retrospective cohort study of all US live births, 2016 (n=3,956,112), using Birth Certificate data. We categorized states into those that adopted Medicaid expansion (+ME), which improves access to PP contraception, and states that provide access to immediate PP-LARCs (https://www.acog.org/About-ACOG/ACOG-Departments/Long-Acting-Reversible-Contraception/Immediate-Postpartum-LARC-Medicaid-Reimbursement). States were classified as: (1) +ME/+LARC, (2) +ME/-LARC, (3) –ME/+LARC, (4) –ME/-LARC. Births from 13 states who adopted ME after 1/1/2014 were not included. Multivariate logistic regression estimated the relative influence of ME and PP-LARCs on the outcome of short IPI (<12 months), after adjusting for maternal race, age, marital status, and WIC. RESULTS: The study population comprised 1,831,665 births to multiparous women with data on IPI among included states. Of those, 50% were in 19 states with +ME/+LARC, 151,999 (8%) in 5 states with +ME/-LARC, 742,836 (40%) in 12 states with –ME/+LARC, and 3,876 (0.2%) in one state with –ME/-LARC. The rate/risk of short IPI was lowest in states with ME plus immediate PP-LARC access (16.17%, 95% CI 16.09-16.25%), adjusted RR 0.926, 95% CI 0.92-0.93). Short IPI rates and adjusted risks were slightly higher in states that adopted only one program or neither: +ME/-LARC 18.05% (CI 17.86-18.25%), -ME/+LARC 18.12% (CI 18.03-18.20%), -ME/-LARC 18.83% (CI 17.60-20.06%), with highest risk in the state with –ME/-LARC, adjRR 1.12, CI 1.05-1.19. CONCLUSION: These data demonstrate that both Medicaid expansion and access to immediate PP LARCs decrease the frequency of short IPI, which may reduce adverse birth outcomes in the US associated with insufficient birth spacing.