PREGNANCY AND FAMILY PLANNING SERVICES AMONG INCARCERATED WOMEN. I. Tong 1 , J.G. Clarke 2 ; 1 Brown University, Department of General Internal Medicine, Providence, RI; 2 Brown University, Providence, RI PURPOSE: Among incarcerated women, pregnancies are often unplanned and high-risk due to high rates of psychiatric disease and illicit drug use. Obtaining birth control can be costly and challenging for this underserved population given its lack of medical insurance and poor access to health care. Offering women an intramuscular injection of progesterone or a three-month supply of oral contraceptive pills prior to their release from prison could prevent or delay potentially high-risk and unwanted pregnancies. In addition to pregnancy prevention, birth control provision would also introduce control and stability into the lives of this disenfranchised population. The aims of this study are to obtain pilot data to determine 1) the number of pregnancies among incarcerated women in Rhode Island and 2) the number of pregnancies occurring within 12 weeks of a prior incarceration. METHODS: Charts of all patients with positive (+) serum beta-human chorionic gonadotropin (b-HCG) values from January 1998 to January 2000 were reviewed. Women who were postpartum or who had a recent termination of pregnancy were excluded from the study. Chi-square and t-tests were used where applicable. RESULTS: A total of 129 women and 140 pregnancies were included in the study. Of the 140 pregnancies, seventy-seven (55%) pregnancies occurred in women with prior incarcerations. Of these 77 pregnancies, 38 (27%) occurred within 12 weeks of a prior release. Women who conceived within 12 weeks of their prior release had a higher number of prior incarcerations (5.5 vs. 3.7, p = 0.0043) and a longer mean length of incarceration during their pregnancy (61.4 days vs. 26.7 days, p = 0.0016). Women who were incarcerated for greater than 30 days during their pregnancy had a higher number of incarcerations (5.3 vs. 3.7, p = 0.0043) and a longer stay during the prior incarceration (58.9 days vs. 21.4 days, p = 0.0082). CONCLUSION: Twenty-seven percent of conceptions among incarcerated women occurred within 3 months of a prior release, suggesting that initiating birth control prior to release from prison could prevent a significant number of pregnancies. Women with potentially preventable pregnancies had multiple prior incarcerations and longer lengths of stay, thus providing multiple opportunities for medical intervention and counseling. Family planning services may also provide cost savings as women with potentially preventable pregnancies have longer lengths of stay while pregnant, thus requiring more financial support for prenatal care. The establishment of a family planning program for incarcerated women would not only provide an important service to a medically underserved population, but it may also be a cost-effective measure for the Department of Corrections. Smoking is strongly related to most health outcomes. However the contribution of smoking behavior to mortality benefits in this group has not been investigated. PURPOSE: In a recent national study, women reported poorer adherence to ART than men but socioeconomic differences may explain this finding. We used a pharmacy-based measure to assess adherence in HIV-infected drug users enrolled in New York State (NYS) Medicaid, a population where men and women have similar socioeconomic backgrounds. METHODS: We analyzed longitudinal claims files for 9,557 non-pregnant HIV+ drug users enrolled in Medicaid > 10 months in each year of 1997 ± 98. In persons prescribed ARVs for > 6 months and on 2+ ARVs for > 2 months in each year, adherence was defined as > 90% days covered by 2+ ARVs from the start of combination therapy through the last prescribed ARV(s) in each year, with inpatient days judged adherent. Demographics and clinical conditions (i.e., HIV, substance abuse, and general medical) and health care factors were identified from eligibility/claims files in 1997. Outpatient care in 1997 was categorized as: regular medical care ( > 35% of visits to one provider); regular substance abuse treatment (6+ months with one provider); both; or neither. We created separate indicators for any care in 1997 from: a provider offering HIV-focused care under NYS Medicaid contract; an infectious diseases (ID) specialist; and a psychiatrist. Two logistic regression models were estimated for adherence to 2+ ARVs in 1997 and, to reduce possible confounding due to concurrent assessment of medical care patterns, adherence to 2+ ARVs in 1998. RESULTS: Of 9,557 persons on Medicaid in 1997 ± 8, 2+ ARVs were prescribed for 4,299 in 1997 4,299 in and 4,589 in 1998 4,299 in . In 1997 .4% of 1,564 women and 37.6% of 2,735 men were > 90% adherent while, in 1998, 34.6% of 1,730 women and 40.3% of 2,186 men were adherent. In both models, the adjusted odds of adherence were lower for women than men (adjusted odds ratio (AOR) 0.67 [CI 0.58, 0.77] Uncertainty about the diagnosis and fear of an episode taking place in a crowded or dangerous situation can influence social functioning. Few and only small studies on quality of life of patients with loss of consciousness have been performed. METHODS: As part of the Dutch Fainting Assessment Trial (FAST) we asked consecutive patients presenting to all departments of the AMC with loss of consciousness to participate in this study. All patients were asked to fill in the SF-36, a generic quality of life questionnaire, and the Syncope Dysfunction Scale (SDS), a previously validated disease-specific questionnaire which assesses specific areas of impairment due to syncope and fear or worry about syncopal spells. RESULTS: Of the first 144 patients 125 (87%) were included in analysis of quality of life. Disease specific impairment was moderate, with acknowledged impairment in 32% of listed activities (e.g. driving, physical activities and ability to work). Fear and worry due to syncope was also moderately high at 40 (SD 29) (possible range 0 ± 100, 0 = no fear or worry, 100 = terrified/ all I do is worry). CONCLUSION: Quality of life in patients with episodes of syncope is seriously affected. Knowledge of problems and fears which these patients encounter are vital knowledge for physicians that can improve patient-doctor understanding and guide (practical) medical advice to this group of patients. PURPOSE: African-Americans and Latinos are more likely to have diabetes and experience worse outcomes from diabetes than Whites. We compared rates of outpatient office visits, emergency ward (EW) visits, and hospitalizations for persons with diabetes by race and ethnicity. We studied Medicaid recipients in New Jersey, thus controlling roughly for income and financial access to care. METHODS: From the 1994 New Jersey State Medicaid Research Files, we identified persons with diabetes by ICD-9-CM diagnosis code or by prescriptions for sulfonylureas or insulin. The final database excluded patients who were: < 18 or > 64 years old; enrolled < 3 months on Medicaid; in Medicaid managed care or Medicare; or pregnant. We compared Black, Hispanic, and White patients, eliminating persons with other or unknown race/ ethnicity. We identified visits using CPT evaluation and management procedure codes for outpatient office visits and for EW services, verifying each by place of service documentation. Unique hospitalizations were identified based on date of admission. We used a Poisson regression multivariate model to examine the effect of race on service use, adjusting for age, sex, reason for Medicaid eligibility, selected co-morbidities, and duration of enrollment. RESULTS: Of 11,841 patients, 44% were Black, 15% were Hispanic, and 41% were White; 73% were women; mean age was 47years; and 66% had claims for sulfonylureas or insulin. Of Blacks 51% had no outpatient visits, compared to 47% of Whites and 42% of Hispanics; 35% of Blacks had at least one hospitalization, as did 31% of Whites and 19% of Hispanics. For outpatient visits, compared to Whites, Blacks had an adjusted relative risk (aRR) of 0.84 (95%CI, 0.79 ± 0.89), and Hispanics had an aRR of 1.00 (0.92 ± 1.08). For EW visits, compared to Whites, Blacks had an aRR of 0.95 (CI, 0.89 ± 1.02), and Hispanics had an aRR of 0.68 (CI, 0.61 ± .077). For hospital admissions, compared to Whites, Blacks had an aRR of 1.21 (CI, 1.14 ± 1.28), and Hispanics had an aRR of 0.91 (CI, 0.82 ± 1.01). Additionally aRR's for all three services differed significantly between Blacks and Hispanics. CONCLUSION: Among persons with diabetes, Blacks had significantly lower rates of outpatient visits and higher hospitalization rates than Whites despite similar incomes and identical insurance benefits. Hispanics had similar outpatient visits and admissions rates, but significantly fewer EW visits than Whites. These results suggest that factors other than income and insurance, such as availability of primary care services and physician-patient factors, contribute to differences in utilization by race and ethnicity. 18) . We defined South Asian as patients who state on registration forms that they speak Bengali, Gujarati, Hindi, Punjabi, Nepalese or Urdu in the home. We defined diabetic as any patient with a billing diagnosis of diabetes in two or more visits over the last two years. Europid controls are those who meet the same criteria for a diabetes diagnosis and state that they speak English in the home. We controlled for socioeconomic class by including only patients who use CHA Free Care or a Medicaid variant as their primary insurance. We compared mean HbA1c, mean LDL cholesterol, and prevalence of microalbuminuria between the two populations. We will continue the analysis with the comparison of BP and ophthalmologic changes, and will report statistical tests of significance for all variables. RESULTS: Sixty-eight of 937 (7.26%) South Asian patients were diabetic, compared with 1,698 of 49,206 (3.45%) Europid patients (RR: 2.10). Mean Hb A1c (8.71% vs. 8.47 %), mean LDL-C (124.17 mg/dl vs. 116.44 mg/dl) and prevalence of microalbuminuria (21% vs. 13%) were all higher in the South Asian patients than in the Europid patients CONCLUSION: The South Asian population is at higher risk of type 2 diabetes mellitus and its complications, and may exhibit poorer metabolic control as compared to the Europid population. Our findings warrant increased research into this population to determine the factors that influence observed differences, and to elaborate culturally appropriate interventions for this high-risk population.