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    Technology and Children: A Parent’s Survival Guide

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    Technology has changed the way children develop and interact with others, and while it seems to change every day, many parents are forced to keep up or get left behind.

    Jessica Mirman, Ph.D., an assistant professor in the Department of Psychology in the University of Alabama at Birmingham College of Arts and Sciences, says that, even though much of technology can receive a bad representation, it is not inherently bad.

    “Parents can be pretty sophisticated with technology when it comes to helping their children develop,” she said. “There are a variety of apps that can help with literacy skills. Especially for children with developmental disabilities, technology can be very helpful at home and in the classroom.”

    Play it safe

    Mirman says technology can be a distraction and a safety hazard across developmental periods.

    “Parents need to be aware of what kinds of devices are in their homes and vehicles,” she said.

    Whether it is about accidentally swallowing button batteries, the tiny batteries often found in musical greeting cards, games, Christmas ornaments and cameras, or the risks of texting and driving, Mirman suggested that parental vigilance can save lives.

    “For example, button batteries are small, shiny, and very appealing to infants and toddlers who may try to ingest them,” she said. “Parents need to keep these and other batteries out of reach and keep devices secure with openings kept shut.”

    The types of technology risks can change with age. According to the National Highway Transportation Safety Administration, in 2015 alone, 3,477 people were killed, and 391,000 were injured in motor vehicle crashes involving distracted drivers. During daylight hours, approximately 660,000 drivers are using cellphones while driving. That creates enormous potential for deaths and injuries on U.S. roads.

    “We always worry about when teens, and parents too, are glued to their phones while driving,” Mirman said. “There is also teen driver safety research that says when parents are calling, teens feel that they are expected to answer, even while driving. Parents need to remember to practice what they preach and model healthy technology habits at home and in the vehicle.”

    What’s trending?

    Social media is another way technology changes how people develop, according to Mirman. She says social media is a good tool to keep people connected; but there are guidelines and boundaries parents need to set, starting again, with practicing what they preach.

    “Parents should practice moderation and respect for others on social media,” Mirman said. “Kids are very observant, and they will pick up on what parents do and often mimic those behaviors.”

    She says children and teenagers are quick to point out any hypocrisy in parents.

    Widespread and improved mobile technology means teens can access social media more easily. According to a Pew survey conducted during 2014 and 2015, 94 percent of teens who go online using a mobile device do so daily.

    Mirman says parents who monitor their children’s social media usage need to start early to develop a foundation of trust with their teens. Parents cannot be around all the time, and teenagers will need to understand why they need to follow the rules, even when Mom and Dad are not watching.

    “If an older child or teen really wants to get their hands on something online, they will likely find a way to do it,” Mirman said. “That is why parents need to be clear about their reasoning for why the rules are in place and not just be an enforcer of the rules.”

    Screen time

    According to the American Academy of Pediatrics, children younger than 18 months should avoid the use of screen media. Between ages 18 months and 24 months, some screen-time can be introduced, with parental supervision. Between the ages of 2 and 5 years, a maximum of one hour a day is recommended. For children above the age of 6, consistent time limits should be established.

    Marcela Frazier, O.D., an associate professor in the UAB Department of Ophthalmology, says the amount of screen time a child has can have a negative impact on their eyesight.

    “The more time children spend on devices, the less time they spend outdoors, and spending time outdoors could slow down the progression of nearsightedness, which is becoming more and more prevalent in children,” Frazier said. “Prolonged exposure to the screens of devices can cause eye fatigue, eye irritation and headaches due to the increased demand on the visual system and the tendency to not blink while using them.”

    Frazier says adults usually report symptoms like eyestrain, dryness, headaches and eye irritation after prolonged use of near devices; however, children may experience these issues and not be able to communicate them accurately. Parents may notice some signs of eye irritation and fatigue related to screen-time in children manifested as excessive blinking, squinting, watery eyes, red eyes and some eye-rubbing.

    The flip side

    Mirman says much research has been done involving children and technology, but what happens when the parents are addicted to tech?

    “If parents are distracted, they can’t pay attention to their children,” Mirman said. “Kids notice this quickly.”

    She says, by being distracted with technology, parents can make their children feel rejected or unimportant. A more fluid boundary between home and work can add to that distraction.

    Finding a remedy

    Mirman says technology can be good, if used in moderation. Many kids can use age-appropriate video games as positive stimulants, and can use them as a way of positive social interaction with online multiplayer games. This can be especially helpful for socially marginalized children and teens.

    “A lot of kids can make positive connections with others through multiplayer games or social media that they may not necessarily make in person,” she said.

    She says it is important for families to create a positive culture around the phones and devices, and practice what she calls “phone hygiene.”

    “Developing healthy habits is important not just for you but for the well-being of the entire family,” she said.

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    Challenging Assumptions About the Use of Contraception by U.S. Muslim Women

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    By Henna Budhwani and Kristine Ria Hearld

    Contraception is complicated. Reproductive health scholars can comfortably weigh the protective benefits of condom use compared to the convenience of intrauterine devices. However, for most people, contraception continues to be a sensitive subject not appropriate for casual conversation – and consequently many Americans lack an adequate understanding of their contraception options. Likewise, even the best-intentioned clinicians know little about how minority communities engage with reproductive healthcare and utilize contraception. Due to these knowledge gaps, providers of contraceptive services often struggle with how to approach family planning with individuals from minority populations, particularly those belonging to highly stigmatized groups that are underrepresented in scientific research. This can be especially true for “culturally conservative” populations of clients, among whom sex itself is stigmatized and sexual health is not freely discussed in the home or the doctor’s office.

    Knowledge gaps are especially prevalent about the reproductive health behaviors of Muslim women, arguably one of the most understudied populations in the United States. This dearth of research is not surprising, given that Muslim women are part of a religious minority group that experiences ongoing intersectional stigma and discrimination in American public life. Because past studied have sometimes taken advantage of minority and marginalized populations, groups such as Muslim women may be suspicious of researchers and wary of divulging personal information, particularly on sensitive topics like contraception use.

    Nevertheless, good research is needed, because in its absence, pernicious assumptions can take the place of actual evidence – and myths can misinform clinicians and policymakers as well as the general public. Social scientists therefore have a pressing calling to conduct research that may ultimately dispel harmful myths and give voice to a group of women missing from academic discourse. Our work examines this set of issues, contraception use and reproductive health preferences, in Muslim women in the United States. We collected information from Muslim women themselves about their lives, and our findings refute presumptions that women in this population typically experience low bodily autonomy and high sexual risk factors.

    Path-Breaking Research from the Muslim Women’s Health Project

    In 2015, the Back of the Envelope mechanism at the University of Alabama at Birmingham School of Public Health funded a grant to collect exploratory data from Muslim women across the United States. Our research team developed an online survey that included measures of stigma, mental health, and contraceptive use among participants. Respondents were women who self-identified as Muslim and who were at least eighteen years old and current residents of the United States. To be sure, online surveys have limitations – for example, American Muslim women who did not have a computer in their home or did not regularly use the Internet would likely not have been exposed to the survey at all. Nevertheless, one major benefit of online surveys is their ability to engage difficult-to-reach populations, including respondents in stigmatized populations, minority enclaves, and groups fearing persecution. Data from our respondents, including participants from Muslim subgroups, were analyzed to identify notable barriers and facilitators to various kinds of contraception use – namely use of oral contraceptive pills, condoms, intrauterine devices, and reliance on withdrawal during sex.

    In the United States as a whole, some national estimates suggest that 62% to 75% of women of reproductive age use contraceptives. Rates of contraception use by women in Muslim majority countries varies widely, from a low rate of use by 38.5% of reproductive-age women in Pakistan and to a high rate of use by 62.3% of such women in Indonesia. Because of these statistics, we assumed Muslim women in the United States would use contraceptives at a higher rate than their counterparts in Muslim majority countries, but at a lower rate than other women in the wider-population of Americans.

    Results from our survey showed that our hypotheses were wrong. We found that almost 80% of eligible Muslim respondents used some form of contraception. As we delved further into characteristics of our sample, we realized that the women who responded to the survey tended to be highly educated (over half had completed graduate or professional school) and had relatively high incomes (43% had a household income of over $100,000 annually). They also had high rates of health insurance coverage, given that fewer than six percent were uninsured. A deeper investigation through multivariate analysis showed that education and income were more important to understanding contraception use than religion, ethnicity, or even immigrant status (whether a respondent was born in the United States or elsewhere).

    Essentially, our inquiry found was that when the social playing field is leveled through higher education, increased income, and full access to health insurance, contraceptive utilization increases – even among populations that are predominantly foreign-born and where people may be religious or hail from culturally conservative communities where women hold a secondary social status. Such factors are typically associated with low contraception use, but in our study, we found these factors could be counteracted by positive social conditions associated with empowerment.

    Why Policymakers and Advocates Should Further Overall Improvements

    When officials or advocates aim to boost contraceptive use by racial and ethnic minorities in order to reduce unintended pregnancies and sexually transmitted infections, it may be valuable to address community conditions holistically. Working patient by patient in health care settings can be helpful, but this approach is limited in scope, costly in time, and influences only the identified, targeted health behaviors. The better approach may be to expand women’s overall access to advanced educational opportunities that can lead to socioeconomic success and improved quality of life – even for women who belong to culturally conservative communities. Overall empowerment, we conclude, is the best way to increase rates of contraceptive use and ensure better life choices and opportunities for women in all communities.

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    Democrat-Led States Tended to Have Stronger Response to COVID-19, Which Improved Health Outcomes, Study Shows

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    BINGHAMTON, N.Y. — States with Democratic leaders tended to have responded more strongly to COVID-19 and have seen a lower rate of the spread of the virus, according to new research led by faculty at Binghamton University, State University of New York.

    Binghamton University Professor of Political Science Olga Shvetsova and her colleagues wanted to gain a clearer understanding of how politics affect COVID-19 outcomes. The researchers used data on public health measures taken across the United States to build an index of the strength of the COVID policy response. They combined this index with daily counts of new COVID cases, along with political and other variables that they thought were relevant to the dynamics of the COVID-19 pandemic and governments’ response to it. Using this dataset, they assessed the effects of policies on the observed number of new infections and the difference between the policies adopted in Republican-led and Democrat-led states.

    This study connects the aggregate strength of public health policies taken in response to the coronavirus disease 2019 (COVID-19) pandemic in the U.S. states to the governors’ party affiliations and to the state-level outcomes. Understanding the relationship between politics and public health measures can better prepare American communities for what to expect from their governments in a future crisis and encourage advocacy for delegating public health decisions to medical professionals.

    “The state governments led by Democrats, on average, took stricter measures than the state governments led by Republicans, and the states with stricter measures had the virus spread much slower,” said Shvetsova.

    The difference between the policies made in Democrat-led states and those made in Republican-led states corresponded to an about 7-8 percent lower rate of the spread of the virus.

    According to the researchers, these conclusions reinforce the findings of previous studies that application of public health policy was politicized for COVID-19, and this affected health outcomes.

    “The main lesson of this research is that better public health requires a less partisan approach to the making of public health policies,” said Shvetsova.

    Additional researchers and institutions on the study included: Andrei Zhirnov from the University of Exeter, Frank Giannelli from Rutgers University, Michael Catalano, and Olivia Catalano.

    The paper, “Governor’s party, policies, and COVID-19 outcomes: Further Evidence of the Effect,” was published in the American Journal of Preventive Medicine.

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    How Investing in Young Black Women During Sexual & Reproductive Health Care Can Address Inequities

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    Dina took to Google after feeling some discomfort in her pubic area. Although she was in graduate school several hundred miles away, she waited to see a healthcare provider until she could return home. During her visit with her gynecologist, she learned that her intrauterine device had become dislodged and was moving around—this was the cause of the pain. After talking with her healthcare provider, she decided to get a new device inserted within two days. This outcome was relieving, because what she had found online had scared her and created additional uncertainty around the symptoms she was experiencing. While Dina was able to find the support she needed from her provider, she also experienced a delay in care because she was unsure that she could expect the same level of support from a different provider closer to her school. Dina’s story is not unique: due to previous mistreatment in healthcare settings, some young Black women fear contraceptive care visits will be harmful—or, if they have had favorable experiences, that a worse healthcare encounter is likely.

    Aja approached her visit with worry and some optimism. She had been experiencing pain during sexual activity that was becoming increasingly bothersome. She reluctantly shared this information during her annual visit with her gynecologist. Despite having seen more than five different providers over the years for this issue, this provider was the first to empathize with her and acknowledge that sex should not be painful. Although Aja already understood this, hearing it from her healthcare provider and coming up with a plan to find a solution were healing for her. This provider explained the various tests she would order and the reasons why, and solicited Aja’s opinion. Aja described feeling included and informed throughout the visit, and left feeling more at ease and confident that her provider took her seriously. Other providers had not taken the time to listen to her, and often prescribed new methods of birth control without acknowledging her pain or frustration with having to deal with the condition.

    While technical aspects of contraceptive care provision can be improved to save patients’ time and money, social and emotional aspects of care provision should not be overlooked. Interviews with cisgender Black women ages 18-29 about their experiences receiving contraceptive care highlighted how important it was to feel heard, understood, and included during provider visits. Women appreciated when providers took the time to empathize, especially if they presented to visits with uncertainty, unexplained pain, and other health issues. These findings demonstrate a need for health systems to “put the care back into health care” and focus on sexual and reproductive health and well-being as a primary goal of healthcare encounters. Health systems can equip providers to engage patients in ways that are adequate, affirming, and responsive to their health needs, especially for those who have historically experienced neglect and mistreatment by health care providers.

    Although health care systems would likely believe that their providers offer care that is person-centered and high-quality, women’s narratives do not align with these perspectives.

    How to Invest in Contraceptive Care Services for Young Black Women

    Before engaging with patients in the clinic, providers should:

    • Learn about and acknowledge the role structural oppressions have on people’s access to contraception and health care in general, and
    • Engage in training and education related to cultural humility and person-centered contraceptive care.

    During visits, providers should:

    • Greet patients warmly and consider sitting, rather than standing next to a seated patient
    • Ask the patient about what they want to discuss during the visit
    • Inform them of care procedures and processes before performing them
    • Engage individuals in a dialogue around their health, providing appropriate and relevant education as needed
    • Engage in active listening, asking questions for clarification and repeating back pertinent information
    • Take the patients’ concerns seriously, demonstrate empathy
    • Gain their permission before placing orders
    • If patients experience physical or emotional discomfort during visits or examination, try to reduce discomfort, stop performing the procedure, and ask what could mitigate discomfort
    • Acknowledge when they do not have the answers
    • Demonstrate an overall commitment to helping them achieve their goals and sexual and reproductive health and well-being

    A small investment in person-centered care approaches may significantly change the perceptions and experiences of young Black women who use contraceptive care services. As this group has borne the brunt of poor contraceptive care encounters, changing a person’s care experience early in the reproductive health care trajectory may help to address inequities in reproductive healthcare settings. Collectively, contraceptive care service users, healthcare providers, and healthcare systems can work together to achieve sexual and reproductive health and well-being. Health systems can incentivize providers to engage in person-centered contraceptive care approaches by offering training and monitoring person-centered care outcomes. Third party payers focused on ensuring quality provision of healthcare services, including a focus on health equity, could incentivize health systems to implement such measures through pay-for-performance structures. At the provider level, clinicians should partner with service users during visits to establish relationships and foster the trust needed to learn of people’s needs before helping to find solutions. Although the focus here is young cisgender Black women, person-centered and equity-oriented approaches to sexual and reproductive health care can be applied to any service user population—by investing in people, we can help them attain better sexual and reproductive health and better well-being overall.

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