Developing Federal Clinical Care Recommendations for Men

Exploring barriers and strategies for improving sexual and reproductive health access for young men in Sweden: Insights from healthcare providers in youth clinics

METHODS

Youth clinics in Sweden are not reaching young men to the same extent as young women. We conducted a qualitative study to explore healthcare providers' (HCPs) perspectives on the barriers to young men's access to sexual and reproductive health (SRH) services and how youth clinics can better accommodate the needs of young men. We used thematic analysis to analyze eight interviews with nine HCPs (three men and six women).

RESULTS

We developed three themes: 1) It's about the youth clinics and those working in them-the clinics suffered from low organizational support, which affected their ability to accommodate young men's needs and were perceived as "girls' clinics". Midwifery, which is the main profession of HCPs working with SRH in the clinics, was perceived as a women's profession for women's SRH; 2) It's not all about the youth clinics-young men were perceived as lacking essential knowledge about SRH and gender norms were preventing young men from visiting youth clinics; 3) Organizational strategies for improving access-the participants discussed strategies to attract young men, including separate reception for young men, hiring more male staff, having higher age limits for young men, and digital solutions to address privacy concerns.

CONCLUSION

There is a need for societal efforts to increase young men's knowledge about SRH and improve their access to SRH services. Several strategies can be adapted by youth clinics to attract more young men but there is need for further research to design and evaluate such interventions.

Evaluation of an Adapted Project Connect Community-based Intervention Among Professionals Serving Young Minority Men

BACKGROUND

To address sexual and reproductive health (SRH) needs of young minority urban males, we developed and evaluated Project Connect Baltimore (Connect), which was adapted from a program with demonstrated effectiveness among young females. The objectives were to determine (1) the feasibility of Connect as adapted for young minority men, (2) whether the program increased SRH knowledge and resource sharing of youth-serving professionals (YSPs) working with young men, and (3) whether the program improved awareness and use of resources for young minority men in Baltimore City, an urban environment with high rates of sexually transmitted diseases.

METHODS

Connect developed a clinic referral guide for male youth-friendly resources for SRH. The YSPs working with partners and organizations serving young minority men were trained to use Connect materials and pretraining, immediate, and 3-month posttraining surveys were conducted to evaluate program effects. A before-after evaluation study was conducted among young men attending five urban Connect clinics where sexually transmitted disease/human immunodeficiency virus rates are high, recruiting young men in repeated cross-sectional surveys from April 2014 to September 2017.

RESULTS

Two hundred thirty-five YSPs were trained to use Connect materials, including a website, an article-based pocket guide, and were given information regarding SRH for young men. These professionals demonstrated increased knowledge about SRH for young men at immediate posttest (60.6% to 86.7%, P < 0.05), and reported more sharing of websites for SRH (23% to 62%, P < 0.05) from pretraining to 3-month posttraining. 169 young minority men were surveyed and reported increased awareness of Connect over 3 and a half years (4% to 11%, P = 0.015), although few young men reported using the website to visit clinics.

CONCLUSIONS

Project Connect Baltimore increased knowledge of SRH needs among youth-serving professionals and sharing of SRH resources by these professionals with young men. This program also demonstrated increases in awareness of SRH resources among young minority urban men.

Advocating for Adolescent and Young Adult Male Sexual and Reproductive Health: A Position Statement From the Society for Adolescent Health and Medicine

There is a critical need to improve the sexual and reproductive health (SRH) education and care of adolescent and young adult (AYA) males around the globe, as SRH is a basic human right for all AYAs. This special attention toward the SRH of AYA males is warranted given the fact that they often have difficulty accessing SRH services and education relative to their female counterparts and have higher rates of sexual risk behaviors than females. To promote AYA males' SRH and the health of their sexual partners and children, the Society for Adolescent Health and Medicine (SAHM) recommends that leaders in research, policy, public health, and clinical practice develop and implement evidence-based, comprehensive SRH education that supports AYA males at school, within communities and families, and through healthcare services that are developmentally appropriate, gender affirming, inclusive of, and informed by AYA males. Additionally, SAHM recommends that healthcare systems and healthcare professionals (HCPs) across disciplines establish and implement competencies for SRH education and skills preparation to meet the unique needs of AYA males across diverse healthcare and community settings. This statement examines multilevel barriers that AYA males face in accessing comprehensive SRH education and services and makes recommendations aligned with the World Health Organization's 2030 Sustainable Development Goals to address such barriers, improve AYA male SRH, and promote overall gender equity in SRH services.

Sexual and Reproductive Health Care Receipt Among Young Males Aged 15-24

PURPOSE

This study aimed to describe young men's sexual and reproductive health care (SRHC) receipt by sexual behavior and factors associated with greater SRHC receipt.

METHODS

There were 427 male patients aged 15-24 who were recruited from 3 primary care and 2 sexually transmitted disease (STD) clinics in 1 urban city. Immediately after the visit, the survey assessed receipt of 18 recommended SRHC services across four domains: screening history (sexual health, STD/HIV test, family planning); laboratories (STDs/HIV); condom products (condoms/lubrication); and counseling (STD/HIV risk reduction, family planning, condoms); in addition, demographic, sexual behavior, and visit characteristics were examined. Multivariable Poisson regressions examined factors associated with each SRHC subdomain adjusting for participant clustering within clinics.

RESULTS

Of the participants, 90% were non-Hispanic black, 61% were aged 20-24, 90% were sexually active, 71% had female partners (FPs), and 20% had male or male and female partners (M/MFPs). Among sexually active males, 1 in 10 received all services. Half or more were asked about sexual health and STD/HIV tests, tested for STDs/HIV, and were counseled on STD/HIV risk reduction and correct condom use. Fewer were asked about family planning (23%), were provided condom products (32%), and were counseled about family planning (35%). Overall and for each subdomain, never sexually active males reported fewer services than sexually active males. Factors consistently associated with greater SRHC receipt across subdomains included having M/MFPs versus FPs, routine versus non-STD-acute visit, time alone with provider without parent, and seen at STD versus primary care clinic. Males having FPs versus M/MFPs reported greater family planning counseling.

CONCLUSIONS

Findings have implications for improving young men's SRHC delivery beyond the narrow scope of STD/HIV care.

Receipt of Selected Preventive Health Services for Women and Men of Reproductive Age - United States, 2011-2013

Problem/Condition

Receipt of key preventive health services among women and men of reproductive age (i.e., 15–44 years) can help them achieve their desired number and spacing of healthy children and improve their overall health. The 2014 publication Providing Quality Family Planning Services: Recommendations of CDC and the U.S. Office of Population Affairs (QFP) establishes standards for providing a core set of preventive services to promote these goals. These services include contraceptive care for persons seeking to prevent or delay pregnancy, pregnancy testing and counseling, basic infertility services for those seeking to achieve pregnancy, sexually transmitted disease (STD) services, and other preconception care and related preventive health services. QFP describes how to provide these services and recommends using family planning and other primary care visits to screen for and offer the full range of these services. This report presents baseline estimates of the use of these preventive services before the publication of QFP that can be used to monitor progress toward improving the quality of preventive care received by women and men of reproductive age.

Period Covered

2011–2013.

Description of the System

Three surveillance systems were used to document receipt of preventive health services among women and men of reproductive age as recommended in QFP. The National Survey of Family Growth (NSFG) collects data on factors that influence reproductive health in the United States since 1973, with a focus on fertility, sexual activity, contraceptive use, reproductive health care, family formation, child care, and related topics. NSFG uses a stratified, multistage probability sample to produce nationally representative estimates for the U.S. household population of women and men aged 15–44 years. This report uses data from the 2011–2013 NSFG.

The Pregnancy Risk Assessment Monitoring System (PRAMS) is an ongoing, state- and population-based surveillance system designed to monitor selected maternal behaviors and experiences that occur before, during, and shortly after pregnancy among women who deliver live-born infants in the United States. Annual PRAMS data sets are created and used to produce statewide estimates of preconception and perinatal health behaviors and experiences. This report uses PRAMS data for 2011–2012 from 11 states (Hawaii, Maine, Maryland, Michigan, Minnesota, Nebraska, New Jersey, Tennessee, Utah, Vermont, and West Virginia).

The National Health Interview Survey (NHIS) is a nationally representative survey of noninstitutionalized civilians in the United States. NHIS collects data on a broad range of health topics, including the prevalence, distribution, and effects of illness and disability and the services rendered for or because of such conditions. Households are identified through a multistage probability household sampling design, and estimates are produced using weights that account for the sampling design, nonresponse, and poststratification adjustments. This report uses data from the 2013 NHIS for women aged 18–44 years.

Results

Many preventive health services recommended in QFP were not received by all women and men of reproductive age. For contraceptive services, including contraceptive counseling and advice, 46.5% of women aged 15–44 years at risk for unintended pregnancy received services in the past year, and 4.5% of men who had vaginal intercourse in the past year received services in that year. For sexually transmitted disease (STD) services, among all women aged 15–24 years who had oral, anal, or vaginal sex with an opposite sex partner in the past year, 37.5% were tested for chlamydia in that year. Among persons aged 15–44 years who were at risk because they were not in a mutually monogamous relationship during the past year, 45.3% of women were tested for chlamydia and 32.5% of men were tested for any STD in that year. For preconception care and related preventive health services, data from selected states indicated that 33.2% of women with a recent live birth (i.e., 2–9 months postpartum) talked with a health care professional about improving their health before their most recent pregnancy; of selected preconception counseling topics, the most frequently discussed was taking vitamins with folic acid before pregnancy (81.2%), followed by achieving a healthy weight before pregnancy (62.9%) and how drinking alcohol (60.3%) or smoking (58.2%) during pregnancy can affect a baby. Nationally, among women aged 18–44 years irrespective of pregnancy status, 80.9% had their blood pressure checked by a health care professional and 31.7% received an influenza vaccine in the past year; 54.5% of those with high blood pressure were tested for diabetes, 44.9% of those with obesity had a health care professional talk with them about their diet, and 55.2% of those who were current smokers had a health professional talk with them about their smoking in the past year. Among all women aged 21–44 years, 81.6% received a Papanicolaou (Pap) test in the past 3 years.

Receipt of certain preventive services varied by age and race/ethnicity. Among women with a recent live birth, the percentage of those who talked with a health care professional about improving their health before their most recent pregnancy increased with age (range: 25.9% and 25.2% for women aged ≤19 and 20–24 years, respectively, to 35.9% and 37.8% for women aged 25–34 and ≥35 years, respectively). Among women with a recent live birth, the percentage of those who talked with a health care professional about improving their health before their most recent pregnancy was higher for non-Hispanic white (white) (35.2%) compared with non-Hispanic black (black) (30.0%) and Hispanic (26.0%) women. Conversely, across most STD screening services evaluated, testing was highest among black women and men and lowest among their white counterparts.

Receipt of many preventive services recommended in QFP increased consistently across categories of family income and continuity of health insurance coverage. Prevalence of service receipt was highest among women in the highest family income category (>400% of federal poverty level [FPL]) and among women with insurance coverage for each of the following: contraceptive services among women at risk for unintended pregnancy; medical services beyond advice to help achieve pregnancy; vaccinations (hepatitis B and human papillomavirus [HPV], ever; tetanus, past 10 years; influenza, past year); discussions with a health care professional about improving health before pregnancy and taking vitamins with folic acid; blood pressure and diabetes screening; discussions with a health care professional in the past year about diet, among those with obesity; discussions with a health care professional in the past year about smoking, among current smokers; Pap tests within the past 3 years; and mammograms within the past 2 years.

Interpretation

Before 2014, many women and men of reproductive age were not receiving several of the preventive services recommended for them in QFP. Although differences existed by age and race/ethnicity, across the range of recommended services, receipt was consistently lower among women and men with lower family income and greater instability in health insurance coverage.

Public Health Action

Information in this report on baseline receipt during 2011–2013 of preventive services for women and men of reproductive age can be used to target improvements in the use of recommended services through the development ofresearch priorities, information for decision makers, and public health practice. Health care administrators and practitioners can use the information to identify subpopulations with the greatest need for preventive services and make informed decisions on resource allocation. Public health researchers can use the information to guide research on the determinants of service use and factors that might increase use of preventive services. Policymakers can use this information to evaluate the impact of policy changes and assess resource needs for effective programs, research, and surveillance on the use of preventive health services for women and men of reproductive age.

American Indian and Alaska Native Men's Use of Sexual Health Services, 2006-2010

CONTEXT

American Indian and Alaska Native men experience poorer sexual health than white men. Barriers related to their sex and racial identity may prevent them from seeking care; however, little is known about this population's use of sexual health services.

METHODS

Sexual health service usage was examined among 923 American Indian and Alaska Native men and 5,322 white men aged 15-44 who participated in the 2006-2010 National Survey of Family Growth. Logistic regression models explored differences in service use by race and examined correlates of use among American Indians and Alaska Natives.

RESULTS

Among men aged 15-19 and those aged 35-44, men with incomes greater than 133% of the federal poverty level, men with private insurance, those living in the Northeast and those living in rural areas, American Indians and Alaska Natives were more likely than whites to use STD or HIV services (odds ratios, 1.5-3.2). The odds of birth control service use did not differ by race. Differences in service use were found among American Indian and Alaska Native men: For example, those with a usual source of care had elevated odds of using sexual health services (1.9-3.4), while those reporting no recent testicular exam had reduced odds of using these services (0.3-0.4).

CONCLUSIONS

This study provides baseline data on American Indian and Alaska Native men's use of sexual health services. Research exploring these men's views on these services is needed to help develop programs that better serve them.

Male Attendance at Title X Family Planning Clinics - United States, 2003-2014

Although both men and women have reproductive health care needs, family planning providers traditionally focus services toward women (1,2). Challenges in providing family planning services to men, including preconception health, infertility, contraceptive, and sexually transmitted disease (STD) care (3,4), include their infrequent use of preventive health services, a perceived lack of need for these services (1,5), and the lack of provider guidance regarding men's reproductive health care needs (4). Since 1970, the National Title X Family Planning Program has provided cost-effective and confidential family planning and related preventive health services with priority for services to low-income women and men. To examine men's use of services at Title X service sites, CDC and the U.S. Department of Health and Human Services' Office of Population Affairs (OPA) analyzed data from the 2003-2014 Family Planning Annual Reports (FPAR), annual data that are required of all Title X-funded agencies. During 2003-2014, 3.8 million males visited Title X service sites in the United States and the percentage of family planning users who were male nearly doubled from 4.5% (221,425 males) in 2003 to 8.8% (362,531 males) in 2014. In 2014, the percentage of family planning users who were male varied widely by state, ranging from ≤1% in Mississippi, Tennessee, and Alabama to 27.2% in the District of Columbia (DC). Title X service sites are increasingly providing services for males. Health care settings might want to adopt the framework employed by Title X clinics to better provide family planning and related preventative services to men (3).

Four aspects of the scope and quality of family planning services in US publicly funded health centers: Results from a survey of health center administrators

OBJECTIVES

This study aims to describe aspects of the scope and quality of family planning services provided by US publicly funded health centers before the release of relevant federal recommendations.

STUDY DESIGN

Using nationally representative survey data (N=1615), we describe four aspects of service delivery: family planning services provided, contraceptive methods provided onsite, written contraceptive counseling protocols and youth-friendly services. We created a count index for each issue and used multivariable ordered logistic regression to identify health center characteristics associated with scoring higher on each.

RESULTS

Half of the sample received Title X funding and about a third each were a community health center or health department clinic. The vast majority reported frequently providing contraceptive services (89%) and STD services (87%) for women in the past 3 months. Service provision to males was substantially lower except for STD screening. A total of 63% and 48% of health centers provided hormonal IUDs and implants onsite in the past 3 months, respectively. Forty percent of health centers included all five recommended contraceptive counseling practices in written protocols. Of youth-friendly services, active promotion of confidential services was among the most commonly reported (83%); offering weekend/evening hours was among the least (42%). In multivariable analyses, receiving Title X funding, having larger volumes of family planning clients and being a Planned Parenthood clinic were associated with higher scores on most indices.

CONCLUSION

Many services were consistent with the recommendations for providing quality family planning services, but there was room for improvement across domains and health centers types.

IMPLICATIONS STATEMENT

As assessed in this paper, the scope and quality of these family planning services was relatively high, particularly among Planned Parenthood clinics and Title X-funded centers. However, results point to important areas for improvement. Future studies should assess change as implementation of recent family planning service recommendations continues.

From 'D' to 'I': A critique of the current United States preventive services task force recommendation for testicular cancer screening

In 2004, the United States Preventive Services Task Force (USPSTF) gave testicular cancer (TCa) screening a ‘D’ recommendation, discouraging the use of this preventive service. The USPSTF suggested that screening, inclusive of testicular self-examination (TSE) and clinician examination, does not reduce TCa mortality rates and that the high risk of false positives could serve as a detriment to patient quality of life. Others suggests that TCa screening is ineffective at detecting early-stage cases of TCa and readily highlights a lack of empirical evidence demonstrating said efficacy. These assertions, however, stand in stark contrast to the widely held support of TCa screening among practicing public health professionals, advocacy groups, and clinicians.

In this present study, a review was conducted of the methods and processes used by the USPSTF in their 2011 reaffirmation of the ‘D’ grade recommendation. The evidence base and commentary offered as to why TSE, as part of the overall recommendation for TCa screening, was given a ‘D’ grade were analyzed for logical reasoning and methodological rigor.

Considering the methodological flaws and the veritable lack of evidence needed to grant a conclusive recommendation, the question is raised if the current ‘D’ grade for TCa screening (i.e. discourage the use of said service) should be changed to an ‘I’ statement (i.e. the balance of benefits and harms is indeterminate). Therefore the purpose of this paper is to present the evidence of TCa screening in the context of efficacy and prevention in order for the field to reassess its relative value.

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The USPSTF gave testicular cancer screening a ‘D’ rating, discouraging its practice.

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We discover methodological flaws and a lack of evidence needed to grant a D rating.

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The D rating contrasts with the widely held support of TCa screening among practitioners.

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The question is raised if the ‘D’ rating for TCa screening should be changed to an ‘I′ statement.