The Presence and Consequences of Abortion Aversion in Scientific Research Related to Alcohol Use during Pregnancy.

Recent research has found that most U.S. state policies related to alcohol use during pregnancy adversely impact health. Other studies indicate that state policymaking around substance use in pregnancy-especially in the U.S.-appears to be influenced by an anti-abortion agenda rather than by public health motivations. This commentary explores the ways that scientists' aversion to abortion appear to influence science and thus policymaking around alcohol and pregnancy. The three main ways abortion aversion shows up in the literature related to alcohol use during pregnancy include: (1) a shift from the recommendation of abortion for "severely chronic alcoholic women" to the non-acknowledgment of abortion as an outcome of an alcohol-exposed pregnancy; (2) the concern that recommendations of abstinence from alcohol use during pregnancy lead to terminations of otherwise wanted pregnancies; and (3) the presumption of abortion as a negative pregnancy outcome. Thus, abortion aversion appears to influence the science related to alcohol use during pregnancy, and thus policymaking-to the detriment of developing and adopting policies that reduce the harms from alcohol during pregnancy

Costs associated with policies regarding alcohol use during pregnancy: Results from 1972-2015 Vital Statistics.

Background and objectiveAs of 2016, 43 US states have policies regarding alcohol use during pregnancy. A recent study found that out of eight state-level alcohol/pregnancy policies, six are significantly associated with poorer birth outcomes, and two are not associated with any outcomes. Here we estimate the excess numbers of low birthweight (LBW) and preterm births (PTB) related to these policies and their associated additional costs in the first year of life.MethodsCost study using birth certificate data for 155,446,714 singleton live births in the United States between 1972-2015. Exposures were state- and month/year-specific indicators of having each of eight alcohol/pregnancy policies in place. Outcomes were excess numbers of LBW and PTB and associated costs in the first year of life. Fixed effects regressions with state-specific time trends were used for statistical analyses in 2018.ResultsIn 2015, policies mandating warning signs were associated with an excess of 7,375 LBW; policies defining alcohol use during pregnancy as child abuse/neglect were associated with an excess of 12,372 PTB; these excess adverse outcomes are associated with additional costs of $151,928,002 and$582,698,853 in the first year of life, respectively.ConclusionsMultiple state-level alcohol pregnancy policies lead to increased prevalence of LBW and PTB, which cost hundreds of millions of dollars annually. Policymakers should consider adverse public health impacts of alcohol/pregnancy policies before expanding extant policies to new substances or adopting existing policies in new states

The development of facility standards for common outpatient procedures and implications for the context of abortion.

BackgroundIn recent years, an increasing number of states have enacted laws that impose specific requirements for facilities in which abortions are performed. In this study, we sought to understand the processes used to develop facility standards in the context of other, less politically charged areas of health care and consider implications for the context of abortion.MethodsWe conducted key informant interviews with 20 clinicians and accreditation professionals involved in facility standards development for common outpatient procedures (endoscopy, gynecology, oral surgery, plastic surgery). We examined the motivations for and processes used in facility standards development, use of scientific evidence in standards development, and decision-making in the absence of evidence. Interview data were thematically coded and analyzed using an iterative approach.ResultsIn contrast to U.S. state laws that target abortion facilities, standards for other outpatient procedures are commonly set by committees of clinicians organized by professional associations or accreditation organizations. These committees seek to establish standards that ensure patient safety without placing unnecessary burden on clinicians in practice. They aim to create evidence-based standards but can be hampered by lack of relevant research. In the absence of research evidence, committees rely on their clinical expertise and sense of best practices in decision-making. According to respondents, considerations of potential harm (e.g., deeper levels of sedation, invasiveness), rather than the specific procedure, should prompt additional requirements.ConclusionsIf facility standards in the context of abortion were developed through processes similar to other outpatient procedures, 1) professionals who perform the procedure would be involved in standards development and 2) in the absence of clear research evidence, the expertise of clinicians, and the guidelines and standards of other organizations, are used to describe a best practice standard of care

The Gender Reservation Wage Gap: Evidence form British Panel Data

Our findings suggest the existence of a gender reservation wage gap. The presence of children, particularly pre-school age children, plays an important role in determining the proportion of this gap that can be explained by individual characteristics. For individuals without children, the unexplained component of the differential is 99% compared to only 22% for those with pre-school age children, which might indicate that perceived discrimination in the labour market influences the reservation wage setting of females.reservation wages, wage decomposition

Fast-food offerings in the United States in 1986, 1991, and 2016 show large increases in food variety, portion size, dietary energy, and selected micronutrients

BACKGROUND US national survey data shows fast food accounted for 11% of daily caloric intake in 2007-2010. OBJECTIVE To provide a detailed assessment of changes over time in fast-food menu offerings over 30 years, including food variety (number of items as a proxy), portion size, energy, energy density, and selected micronutrients (sodium, calcium, and iron as percent daily value [%DV]), and to compare changes over time across menu categories (entrées, sides, and desserts). DESIGN Fast-food entrées, sides, and dessert menu item data for 1986, 1991, and 2016 were compiled from primary and secondary sources for 10 popular fast-food restaurants. STATISTICAL ANALYSIS Descriptive statistics were calculated. Linear mixed-effects analysis of variance was performed to examine changes over time by menu category. RESULTS From 1986 to 2016, the number of entrées, sides, and desserts for all restaurants combined increased by 226%. Portion sizes of entrées (13 g/decade) and desserts (24 g/decade), but not sides, increased significantly, and the energy (kilocalories) and sodium of items in all three menu categories increased significantly. Desserts showed the largest increase in energy (62 kcal/decade), and entrées had the largest increase in sodium (4.6% DV/decade). Calcium increased significantly in entrées (1.2%DV/decade) and to a greater extent in desserts (3.9% DV/decade), but not sides, and iron increased significantly only in desserts (1.4% DV/decade). CONCLUSIONS These results demonstrate broadly detrimental changes in fast-food restaurant offerings over a 30-year span including increasing variety, portion size, energy, and sodium content. Research is needed to identify effective strategies that may help consumers reduce energy intake from fast-food restaurants as part of measures to improve dietary-related health issues in the United States.Accepted manuscrip

Issue 13: Syrian Refugee Resettlement and the Role of Local Immigration Partnerships (LIPs) in Ontario, Canada

During the peak of the Syrian refugee “crisis” in 2015 and early 2016, the Canadian Federal Government responded with a push to drastically increase the number of Syrian refugees it planned to resettle. The resulting Syrian Refugee Resettlement Initiative (SRRI) put to the test Local Immigration Partnerships (LIPs), a form of place-based policy that had been in place since 2008 where communities collaborate in the support, development and execution of local immigration and refugee resettlement plans. This issue of Policy Points discusses a study of three LIPs (Hamilton, Ottawa, and Waterloo Region) and their response to the SRRI. The research provides three policy insights relevant to refugee and immigrant community resettlement. Bringing the community into the fold through multi stakeholder tables such as LIPs can coordinate local responses to the resettlement of refugees (policy insight 1). LIPs must be embedded in the local community and include leaders and personnel able to build and enhance local stakeholder networks (policy insight 2). Finally, it is key to involve LIPs in communication channels during mass resettlement events (policy insight 3). Policy action under points 2 and 3 will in turn enable LIPs to effectively support refugee resettlement at the local level. The experience of the three Ontario LIPs in this study is relevant to existing and potential new LIPs, but it also offers a unique place-based policy approach to engaging local communities in resettlement at other locations and scales

Wave heating from proto-neutron star convection and the core-collapse supernova explosion mechanism

Our understanding of the core-collapse supernova explosion mechanism is incomplete. While the favoured scenario is delayed revival of the stalled shock by neutrino heating, it is difficult to reliably compute explosion outcomes and energies, which depend sensitively on the complex radiation hydrodynamics of the post-shock region. The dynamics of the (non-)explosion depend sensitively on how energy is transported from inside and near the proto-neutron star (PNS) to material just behind the supernova shock. Although most of the PNS energy is lost in the form of neutrinos, hydrodynamic and hydromagnetic waves can also carry energy from the PNS to the shock. We show that gravity waves excited by core PNS convection can couple with outgoing acoustic waves that present an appreciable source of energy and pressure in the post-shock region. Using one-dimensional simulations, we estimate the gravity wave energy flux excited by PNS convection and the fraction of this energy transmitted upwards to the post-shock region as acoustic waves. We find wave energy fluxes near 10⁵¹ergs⁻¹ are likely to persist for ∼1s post-bounce. The wave pressure on the shock may exceed 10 per cent of the thermal pressure, potentially contributing to shock revival and, subsequently, a successful and energetic explosion. We also discuss how future simulations can better capture the effects of waves, and more accurately quantify wave heating rates

Complex situations: Economic insecurity, mental health, and substance use among pregnant women who consider - but do not have - abortions.

We examine characteristics and experiences of women who considered, but did not have, an abortion for this pregnancy. Participants were recruited at prenatal care clinics in Louisiana and Maryland for a mixed-methods study (N = 589). On self-administered surveys and structured interviews, participants were asked if they had considered abortion for this pregnancy and, if so, reasons they did not obtain one. A subset (n = 83), including participants who considered abortion for this pregnancy, completed in-depth phone interviews. Multivariable logistic regression analyses examined characteristics associated with having considered abortion and experiencing a policy-related barrier to having an abortion; analyses focused on economic insecurity and of mental health/substance use as main predictors of interest. Louisiana interviews (n = 43) were analyzed using modified grounded theory to understand concrete experiences of policy-related factors. In regression analyses, women who reported greater economic insecurity (aOR 1.21 [95% CI 1.17, 1.26]) and more mental health diagnoses/substance use (aOR 1.29 [1.16, 1.45] had higher odds of having considered abortion. Those who reported greater economic insecurity (aOR 1.50 [1.09, 2.08]) and more mental health diagnoses/substance use (aOR 1.45 [95% CI 1.03, 2.05] had higher odds of reporting policy-related barriers. Interviewees who considered abortion and were subject to multiple restrictions on abortion identified material and instrumental impacts of policies that, collectively, contributed to them not having an abortion. Many described simultaneously navigating economic insecurity, mental health disorders, substance use, and interpersonal opposition to abortion from family and the man involved in the pregnancy. Current restrictive abortion policies appear to have more of an impact on women who report greater economic insecurity and more mental health diagnoses/substance use. These policies work in concert with each other, with people's individual complex situations-including economic insecurity, mental health, and substance use-and with anti-abortion attitudes of other people to make abortion care impossible for some pregnant women to access