Introduction: Young childbearing sexual minority (SM) people are more likely to use cannabis and to have an unintended pregnancy than their heterosexual peers; however, little is known about their perceptions and experiences of peripartum cannabis use. This qualitative study explores the relationships young pregnant and parenting SM people have with cannabis, as well as their feelings and opinions about prenatal cannabis use. Method: Participants who identified as SM from baseline surveys of the YoungMoms study were recruited for semi-structured qualitative interviews (n = 13). Interviews focused on cannabis use experiences before and during pregnancy. Data were analyzed using thematic analysis. Results: Data analysis revealed 3 key themes. Participants described the contextual adaptivity of their cannabis use, discussing how their use changed based on social context, mental health, and stress but was not directly related to their sexuality. Pregnancy was identified as a potential turning point for cannabis use as participants described trying to reduce or abstain during pregnancy, although some struggled to do so or continued use to address pregnancy symptoms. Facilitating factors of prenatal cannabis reduction were described, including focusing on the financial toll, social environment changes, access to health-related guidance, and replacement hobbies. Conclusions: This study provides novel information about a public health concern among a pregnant population that is often overlooked in prenatal substance use research. Similar to their heterosexual peers, pregnancy may serve as an opportune time for intervention among young SM people who use cannabis, but consideration of unique factors that contribute to their cannabis use is needed.

Introduction Sexual minority (SM) youth, especially those who identify as bisexual, have higher rates of nicotine and tobacco use and are more likely to become pregnant at a younger age than heterosexual youth. The goal of this study was to investigate the nicotine and tobacco experiences and motivations of SM people before and during pregnancy.Aims and Methods Pregnant and birthing individuals ages 16-24 who identified as a SM in an online survey were recruited for semi-structured video interviews about nicotine and tobacco use. Thirteen participants described nicotine and tobacco initiation, current or recent use, and cessation efforts. Using thematic analysis, the research team coded de-identified interview transcripts and identified themes related to their nicotine and tobacco use.Results Participants were cisgender women (average age = 19.6). Most identified as bisexual (86%) in addition to Black (36%) or biracial (36%). Four themes about nicotine and tobacco use were identified from participant interviews. Participants' reasons for nicotine and tobacco initiation were social, yet reasons for more regular use were stress-related. Participants' use of cigarettes was triggered by their cannabis use, and several substituted cannabis for cigarettes during cessation attempts. Participants identified pregnancy as a strong motivator to quit smoking, and attempted cessation without clinical assistance.Conclusions Young SM people's greater risk of initiation and dependence on nicotine and tobacco products prior to conception may be related to social needs, stress, and use of cannabis. Current approaches and materials on smoking cessation are not being utilized by this population.Implications This is the first qualitative study of nicotine and tobacco use among young pregnant SM people, primarily bisexual-identified, who are underrepresented in prenatal tobacco research. By telling their own stories, SM participants with lived experience of nicotine and tobacco use described the evolution of their motivations to use these products over time, cannabis use as a precipitant, the importance of pregnancy for smoking cessation, and perceptions about effective and ineffective factors in cessation efforts. The results of this study provide key information for prevention efforts to reduce tobacco-related health disparities for SM people.

Purpose: Sexual minority (SM) youth have higher rates of substance use and pregnancy but are absent from the prenatal substance use literature. We modeled the impact of SM identity and syndemic factors on prenatal substance use among 14- to 21-year-olds. Methods: Pregnant people completed an online survey (n = 357). Prenatal substance use was regressed on SM identity, controlling for other syndemic factors (e.g., depressive symptoms, intimate partner violence) and household substance use. Results: Pregnant SM participants (n = 125) were primarily bisexual and were more likely to use tobacco and illicit drugs than heterosexual participants (n = 232). The association between SM identity and prenatal tobacco use was not attenuated by syndemic factors, prenatal cannabis use, or household tobacco use. Conclusion: SM people need increased support for smoking cessation to redress health inequities in tobacco use, prevent prenatal exposures to tobacco, and limit the long-term consequences of tobacco use on health.

BACKGROUND:The novel coronavirus 2019 (COVID-19) pandemic exacerbated existing health inequities in the United States, but no studies have focused on the lived experiences of younger Black birthing people. The goal of this qualitative study was to center the experiences of younger pregnant and birthing Black and Biracial people during the pandemic.METHODS:We recruited 25 Black and Biracial pregnant and birthing people ages 16-23 for individual semi-structured interviews. Participants were asked about experiences with the healthcare system during the pandemic, and interviews were transcribed verbatim and coded for qualitative analysis using nVivo. We adhered to the Consolidated Criteria for Reporting Qualitative Research guidelines.RESULTS:Participants identified pandemic-related stressors such as fears about infection, lack of support, and pressure to get vaccinated. Reasons for vaccine hesitancy included mistrust in the government and racism experienced during reproductive healthcare. Provider appeals highlighting patient autonomy and science were more effective in encouraging vaccine uptake than emotional appeals that made participants feel guilty about potentially infecting loved ones.CONCLUSIONS:Restrictions on children and support people created barriers to timely prenatal care and reduced tangible support for young Black and Biracial birthing people during the pandemic. Their vaccine hesitancy was related to mistrust, concerns that the vaccines had not been tested enough prior to roll-out, and possible side effects of the vaccine including infection with the virus and pregnancy loss. Obstetric providers need to understand and recognize the ongoing impact of obstetric and scientific racism on health communication with younger Black and Biracial patients.

Abstract Objective The objective of this study was to qualitatively examine coping mechanisms and desired supports in pregnant and birthing Black and Biracial adolescent and young adult women during the COVID-19 pandemic. Methods Black and Biracial participants ages 16–23 were recruited for virtual individual semi-structured interviews. Participants (n = 25) were asked about pre- and post-natal experiences with the healthcare system, effects of the pandemic, and participants’ experiences of or desires for ideal care within the healthcare system. Interviews were transcribed verbatim and coded for qualitative analysis using nVivo. Discussions around postpartum mental health evolved organically when asked about how participants were coping postpartum. Results Nearly half the interviewees organically reported mental health symptoms consistent with postpartum depression (PPD) during questions regarding their postpartum experience. Of the 11 interviewees who reported mental health symptoms consistent with PPD, 2 were afraid to disclose their symptoms to a healthcare provider due to fear of child protective services involvement and their belief they would be treated unfairly because of their race. Conclusion Clinicians who care for Black and Biracial adolescent and young adult mothers must be particularly attuned to structural barriers for appropriate screening and treatment of postpartum depression. Expanding investigations of intersectional influences on young mothers’ perinatal health and PPD are needed.

Objective: To document pregnancy and birthing experiences of young, Black pregnant women in one geographic area to make recommendations for improving young Black women's pregnancy and birthing experiences.Methods: Participants were recruited through The YoungMoms Study (R01 DA04640101A1) in Pittsburgh, Pennsylvania, and included Black or biracial participants ages 16-23 (n = 25). Individual interviews were conducted from March 2022-July 2022 to assess pre-, peri-, and post-natal healthcare system encounters; expe-riences of structural and obstetric racism and discrimination in healthcare settings while obtaining prenatal care; attitudes around healthcare systems and medical professionals; effects of COVID-19 pandemic on participants lives and the impact of enacted healthcare policies in their perinatal experience; substance use changes during pregnancy; and coping mechanisms for stress. NVivo 13 was used to code transcripts, then major themes and subthemes were identified using thematic content analysis and based on grounded theory.Results: Twenty-five interviews were conducted, and four themes emerged from participant experiences of racial discrimination in healthcare settings; (1) awareness of historical racism that influences perinatal care; (2) clinical providers assume participant substance use and enact reproductive coercion; (3) clinical providers question validity of Black women's birthing complaint; and (4) Young Black pregnant women know and will express what they desire in their perinatal experience if asked.Conclusions: Young Black pregnant women encounter structural racism and intersectional bias from healthcare providers. By centering the perspectives and expe-riences of this overlooked population, public health researchers and clinical providers can utilize anti-racist frameworks to create more equitable, just practices in reproductive healthcare.

Objective: The objective of this study was to qualitatively examine coping mechanisms and desired supports in pregnant and birthing Black and biracial adolescent and young adult women during the COVID-19 pandemic. Method: Black and biracial participants ages 16-23 were recruited for virtual individual semi-structured interviews. Participants (n=25) were asked about pre- and post-natal experiences with the healthcare system, effects of the pandemic, and participants' experiences of or desires for ideal care within the healthcare system. Interviews were transcribed verbatim and coded for qualitative analysis using nVivo. Discussions around postpartum mental health evolved organically when asked about how participants were coping postpartum. Results: Nearly half the interviewees reported mental health symptoms consistent with postpartum depression (PPD). Of the 11 interviewees who reported mental health symptoms consistent with PPD, 2 were afraid to disclose their symptoms to a healthcare provider due to fear of child protective services involvement and their belief they would be treated unfairly because of their race. Conclusion: Clinicians who care for Black and biracial adolescent and young adult mothers must be particularly attuned to structural barriers for appropriate screening and treatment of postpartum depression. Expanding investigations of intersectional influences on young mothers' perinatal health and PPD are needed.

Background The migration of health care professionals from developing to developed countries is a trend. This migration benefits the destination countries but is quite often devastating to healthcare systems within the home countries. Skilled practitioners from developing countries forego opportunities in their homelands to migrate to developed countries. This leaves a vacuum of talent, weakening the health systems in the 'home' countries. Methods This piece analyzes the consequence of such migration through the lens of the four principles of Universal Declaration of Bioethics and Human rights (UDBHR): equality, justice and equity, solidarity and cooperation, and sharing of benefits. Results In the light of moral imagination and moral reflection, we can understand one another as global citizens. Policymakers must develop guides to restore balance and ensure equitable healthcare worldwide. Incorporating ethics education in medical schools and hospitals, implementing temporary migration visas, and helping home countries offer attractive compensation can address this concern. Conclusions Health is a universal human right; the well-being of all must be addressed without overly limiting the rights of practitioners to build the lives they imagine. On the other hand, practitioners should consider themselves global citizens and consider their ethical obligations when considering their migration.