Early exposure to medicine as a careeramong high school students in underservedcommunities is crucial for igniting passionand confidence in the next generation ofURM physicians to serve the diversecommunities of California. We hypothesize that after participating in this program, high school students will have increased awareness about the pathway to medicine and interest in pursuing a career in medicine.

The US Census Bureau reports that 15.8% are living at or below the federal poverty level. Additionally, 6.1% of Sacramento County residents under the age of 65 are without health insurance. California’s Family Planning Access Care and Treatment (Family PACT) program was established to ensure that California residents living at or below 200% of the Federal Poverty Level and who do not qualify for health services under Medi-Cal have access to desired contraceptive services (Early, 2018). However, a 2018 study on the availability of long-acting reversible contraception (LARC) provided by Family PACT clinics in Los Angeles County found that of the 336 clinics listed on the Family PACT program website, only 284 were currently participating in Family PACT. Of those clinics that were currently participating in Family PACT, only 61% were able to provide LARC onsite (Natavio, 2018). Since that time, the Family PACT program has issued new guidance instructing all participating clinics to offer LARC onsite. Yet, more recent studies have demonstrated that wide variation even among LARC services offered in these publicly funded centers still remains (Bornstein, 2018).

Undesired pregnancies are difficult for Californian families and costly for the state which covers 50% of deliveries. California’s Family Planning Access Care and Treatment (Family PACT) program is charged with providing free contraceptive services to uninsured individuals living in California, at or below 200% of the Federal Poverty Level. In theory, eligible individuals can enroll in the Family PACT program at the time of a clinic visit and receive same-day clinical services at no cost.

California’s Family Planning Access Care and Treatment (Family PACT) program was established to ensure that all California residents have access to desired contraceptive service, regardless of immigration status. Many California residents speak Spanish.

Objectives

To assess emergency contraception (EC) service provision by California's family planning clinics.

Study design

We made 2 scripted calls to a random sample of 309 family planning clinics.

Results

We reached one hundred ninety-four clinics on 2 occasions, although only 183 (59%) could be reached with the information provided online by California's office of family planning. Of these 194 clinics, 27% responded that the clinic did not provide EC and 43% offered only levonorgestrel EC. Only 1 clinic asked about recent sexual assault and one other about their weight.

Conclusions

Prompt access to effective EC remains challenging in California. Clinic staff responding to requests for EC should provide trauma-informed care.

We present a global atlas of 4,728 metagenomic samples from mass-transit systems in 60 cities over 3 years, representing the first systematic, worldwide catalog of the urban microbial ecosystem. This atlas provides an annotated, geospatial profile of microbial strains, functional characteristics, antimicrobial resistance (AMR) markers, and genetic elements, including 10,928 viruses, 1,302 bacteria, 2 archaea, and 838,532 CRISPR arrays not found in reference databases. We identified 4,246 known species of urban microorganisms and a consistent set of 31 species found in 97% of samples that were distinct from human commensal organisms. Profiles of AMR genes varied widely in type and density across cities. Cities showed distinct microbial taxonomic signatures that were driven by climate and geographic differences. These results constitute a high-resolution global metagenomic atlas that enables discovery of organisms and genes, highlights potential public health and forensic applications, and provides a culture-independent view of AMR burden in cities.