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Kachingwe ON, Phillips DR, Jasczynski M, Hillig E, Chavez R, Tellei J, Aparicio EM. 'I told him I'm gonna get it': intimate partner birth control communication among homeless young women. CULTURE, HEALTH & SEXUALITY 2023; 25:159-175. [PMID: 35020565 DOI: 10.1080/13691058.2021.2025431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 12/31/2021] [Indexed: 06/14/2023]
Abstract
Homeless youth have disproportionately high rates of unintended pregnancy and STIs. Enhancing communication between sexual partners can improve sexual health outcomes, yet little is known about this topic among homeless youth; therefore, this study aimed to examine how homeless youth communicate with their partners about birth control. In-depth semi-structured interviews regarding intimate partner birth control communication were conducted with 10 homeless young women aged 14-22 years following their completion of a comprehensive sexual health program (Wahine Talk). We transcribed the interviews verbatim and used a structured, inductive analytic approach to identify themes. Analysis identified three themes: Getting the Conversation Started, Conversation Content, and Impact of Conversation. Birth control conversations were prompted by programme participation, birth control side effects, and family members' interest in homeless youth becoming pregnant. Barriers to communication included fear and mistimed conversations (e.g. during the initiation of sex). Homeless young people shared simultaneous desires to delay pregnancy and concerns about side effects of birth control use. Discussions about birth control with their partners may demonstrably improve homeless youth's intimate relationships and family planning efforts. Providers can support homeless young women by helping them plan conversation timing and addressing fear, including the risk of violence.
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Affiliation(s)
- Olivia N Kachingwe
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, USA
| | | | - Michelle Jasczynski
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, USA
| | - Emily Hillig
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, USA
| | - Rebecca Chavez
- Youth Outreach (YO!) Program, Waikiki Health, Honolulu, HI, USA
| | | | - Elizabeth M Aparicio
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, USA
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2
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Saloranta TH, Gyllenberg FK, But A, Gissler M, Heikinheimo O, Laine MK. Use of reproductive health services among women using long- or short-acting contraceptive methods - a register-based cohort study from Finland. BMC Public Health 2022; 22:1185. [PMID: 35701805 PMCID: PMC9199191 DOI: 10.1186/s12889-022-13581-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 05/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Long-acting reversible contraceptives (LARCs) have superior contraceptive efficacy compared to short-acting reversible contraceptives (SARCs) and choosing LARCs over SARC methods reduces the need for abortion care. However, little is known how initiating these methods associates with the subsequent overall need of reproductive health services including family planning services, and visits for gynecological reasons in primary and specialized care. METHODS We followed altogether 5839 non-sterilized women aged 15-44 years initiating free-of-charge LARC methods (n = 1689), initiating or switching SARC methods (n = 1524), or continuing with the same SARC method (n = 2626) at primary care family planning clinics in the City of Vantaa, Finland, 2013-2014 for 2 years using Finnish national health registers. We assessed the use of reproductive health services, namely attending public primary or specialized health care for gynecological reasons or attending the family planning clinics by applying unadjusted and adjusted negative binomial regression models on visit counts. RESULTS A total of 11,290 visits accumulated during the two-year follow-up: 7260 (64.3%) at family planning clinics, 3385 (30.0%) for gynecological reasons in primary, and 645 (5.7%) in specialized health care. Altogether 3804 (52.4%) visits at the family planning clinics were for routine checkup, and 3456 (47.6%) for other reasons. Women initiating LARC methods used reproductive health services for reasons other than routine checkups similarly as women initiating or switching SARC methods (adjusted incidence rate ratio 0.93, 95% CI 0.82-1.05), while women continuing with SARC methods used the services less frequently (0.65, 0.59-0.72). Women initiating free-of-charge LARC and those continuing with the same SARC method used services less for abortion care than women initiating or switching SARC (adjusted incidence rate ratios 0.05, 95% CI 0.03-0.08 and 0.16, 95% CI 0.11-0.24, respectively). CONCLUSIONS While women initiating LARC methods have lower need for abortion care compared to women initiating SARC methods, women initiating both LARC and SARC methods have similar overall need for reproductive health services. In contrast, women continuing with their SARC method need reproductive health services less than women initiating LARC or a new SARC method. These service needs should be acknowledged when planning and organizing family planning services, and when promoting long-acting reversible contraception.
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Affiliation(s)
- Tuire Helene Saloranta
- Myyrmäki Health Center, Jönsaksentie 4, 01600, Vantaa, Finland.,Department of General Practice and Primary Care, University of Helsinki, Tukholmankatu 8 B, 00029 HUS, Helsinki, Finland
| | - Frida Katrin Gyllenberg
- Myyrmäki Health Center, Jönsaksentie 4, 01600, Vantaa, Finland.,Department of General Practice and Primary Care, University of Helsinki, Tukholmankatu 8 B, 00029 HUS, Helsinki, Finland.,Department of Obstetrics and Gynecology, University of Helsinki, Haartmaninkatu 2, 00029 HUS, Helsinki, Finland
| | - Anna But
- Department of Public Health, University of Helsinki and Helsinki University Hospital, Tukholmankatu 8 B, 00029 HUS, Helsinki, Finland
| | - Mika Gissler
- Department of Knowledge Brokers, Finnish Institute for Health and Welfare, Mannerheimintie 166, 00271, Helsinki, Finland.,Research Centre for Child Psychiatry, University of Turku, Lemminkäisenkatu 3 (Teutori 3. krs), 20014, Turku, Finland.,Region Stockholm, Academic Primary Health Care Centre, Solnavägen 1 E, 113 65, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institute, Solnavägen 1, 17177, Stockholm, Sweden
| | - Oskari Heikinheimo
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, PO Box 140, FI-00029 HUS, Helsinki, Finland.
| | - Merja Kristiina Laine
- Department of General Practice and Primary Care, University of Helsinki, Tukholmankatu 8 B, 00029 HUS, Helsinki, Finland.,Folkhälsan Research Center, Topeliuksenkatu 20, 00250, Helsinki, Finland
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3
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Gollub EL, Beauvais S, Roye C. College-attending young men's sexual and reproductive health knowledge, attitudes and practices. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:706-716. [PMID: 32432978 DOI: 10.1080/07448481.2020.1762609] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 03/10/2020] [Accepted: 04/26/2020] [Indexed: 06/11/2023]
Abstract
ObjectiveMale involvement in contraceptive practice remains low. Family planning and pediatric health associations have recommended an emphasis on long-acting reversible contraceptives (LARC) in clinical counseling with adolescents and young adults, raising concerns about the resulting adverse impact on sexually transmitted infection (STI) rates. Participants: College-attending men responded to an internet based questionnaire (n=31) and a phone-based qualitative interview (n=25). Methods: Our survey solicited attitudes toward and knowledge of contraceptive methods and assessed communication practices with sexual partners regarding use of contraception and disease prevention. Results: Knowledge about female methods of contraception was low, with a comparatively high level of knowledge about Plan B. Parents and health care providers were cited as the most helpful sources of information. Conversations about protection with sexual partners were reported by most men, due mainly to fear of unplanned pregnancy, not STI. Conclusion: Addressing couple communication and dual protection among college-attending men needs greater emphasis.
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Affiliation(s)
- Erica L Gollub
- Health Science Program, Pace University College of Health Professions, Pleasantville, New York, USA
| | - Shirley Beauvais
- Lienhard School of Nursing, Pace University College of Health Professions, Pleasantville, New York, USA
| | - Carol Roye
- Lienhard School of Nursing, Pace University College of Health Professions, Pleasantville, New York, USA
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4
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Casola AR, Matson PA, Jones RM. Association between relationship characteristics, sexual health attitudes, and dual contraceptive use among young adult college students aged 18-24. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:314-324. [PMID: 32529927 DOI: 10.1080/07448481.2020.1751172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 01/26/2020] [Accepted: 03/29/2020] [Indexed: 06/11/2023]
Abstract
Objective Determine the relationship characteristics, sexual health attitudes, and demographic factors associated with dual contraceptive use among college students. Participants: September-October 2018 via campus email, we recruited College of Public Health students attending a large, urban, public university (N = 424). Methods: Respondents completed a cross-sectional, Web-based sexual health questionnaire. Descriptive statistics were calculated. Multiple logistic regression models were run to determine the association between relationship characteristics, pregnancy and condom attitudes, demographics, and dual use the last time having sex. Results: In independent models, one-unit increase in trust (aOR = 0.982; 95% CI: 0.966-0.998) and commitment score (aOR = 0.987, 95% CI: 0.976-0.999) was inversely associated with dual use while sex with a casual date/acquaintance (aOR = 3.149; 95% CI: 1.550-6.397) was positively associated. In a fully adjusted model for all correlates, only trust score was significant (aOR = 0.982; 95% CI: 0.966, 0.998). Conclusions: Emotion-based constructs may be more influential on dual use behaviors than discrete relationship factors.
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Affiliation(s)
- Allison R Casola
- Department of Epidemiology and Biostatistics, Temple University College of Public Health, Philadelphia, PA, USA
| | - Pamela A Matson
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Resa M Jones
- Department of Epidemiology and Biostatistics, Temple University College of Public Health, Philadelphia, PA, USA
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5
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Fu TC, Herbenick D, Dodge BM, Beckmeyer JJ, Hensel DJ. Long-Acting Reversible Contraceptive Users' Knowledge, Conversations with Healthcare Providers, and Condom Use: Findings from a U.S. Nationally Representative Probability Survey. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2021; 33:163-174. [PMID: 38596749 PMCID: PMC10929580 DOI: 10.1080/19317611.2020.1870024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 12/22/2020] [Accepted: 12/23/2020] [Indexed: 04/11/2024]
Abstract
Objectives To describe long-acting reversible contraceptive (LARC) users' knowledge, patient-provider interactions, and condom use associated with LARC use. Methods: Data are from the 2018 National Survey of Sexual Health and Behavior, a probability survey of Americans aged 14-49. Results: Of 1,451 sexually active women, 11.2% used intrauterine devices, and 3.1% used implants. Approximately 19-26% of LARC users reported inaccurately on LARC longevity, and 30% reported relying on their provider to indicate the timing of intrauterine device removal. Consistent condom use among LARC users was rare (6.1%). Conclusions: Our findings have implications for how clinicians educate patients on LARC and condom use.
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Affiliation(s)
- Tsung-chieh Fu
- Center for Sexual Health Promotion, Indiana University, Bloomington, Indiana, USA
- Department of Applied Health Science, Indiana University, Bloomington, Indiana, USA
| | - Debby Herbenick
- Center for Sexual Health Promotion, Indiana University, Bloomington, Indiana, USA
- Department of Applied Health Science, Indiana University, Bloomington, Indiana, USA
| | - Brian M. Dodge
- Center for Sexual Health Promotion, Indiana University, Bloomington, Indiana, USA
- Department of Applied Health Science, Indiana University, Bloomington, Indiana, USA
| | - Jonathon J. Beckmeyer
- Center for Sexual Health Promotion, Indiana University, Bloomington, Indiana, USA
- Department of Applied Health Science, Indiana University, Bloomington, Indiana, USA
| | - Devon J. Hensel
- Department of Pediatrics, Indiana University School of Medicine, Bloomington, Indiana, USA
- Department of Sociology, Indiana University Purdue University-Indianapolis, Indianapolis, Indiana, USA
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6
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Hendrick CE, Cone JN, Cirullo J, Maslowsky J. Determinants of Long-acting Reversible Contraception (LARC) Initial and Continued Use among Adolescents in the United States. ADOLESCENT RESEARCH REVIEW 2020; 5:243-279. [PMID: 34056060 PMCID: PMC8159026 DOI: 10.1007/s40894-019-00126-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 07/03/2019] [Indexed: 05/28/2023]
Abstract
Long-acting reversible contraception (LARC) has gained attention as a promising strategy for preventing unintended adolescent pregnancies in the United States. However, LARC use among adolescents at risk for pregnancy remains low compared to women in their 20s. The purpose of the current study was to synthesize the empirical literature published between 2010 and 2018 identifying the facilitators of and barriers to adolescents' (< age 20) LARC use in the United States. Thirty quantitative and qualitative studies were included in the current systematic review. The facilitators of and barriers to adolescent LARC use fell within five themes: LARC method characteristics, individual characteristics, social networks, healthcare systems, and historical time and geographical region. Barriers to adolescent LARC use largely echoed those identified in previous research noting the barriers to LARC use among young adult women (e.g., provider concerns with placing IUDs for nulliparous women, common adverse side effects associated with some LARC methods). However, qualitative studies identified adolescents' mothers as central figures in helping adolescents successfully obtain the LARC methods they desired. Conversely, adolescents' partners seemed to only play a minor role in adolescents' contraceptive decisions. Findings within the reviewed studies also suggested some subpopulations of adolescents may be experiencing pressure to initiate LARC use or have less ability to have their LARC device removed if they wish to discontinue use. Adolescent health practitioners and clinicians should consider the unique social-environmental influences of adolescents' contraceptive access and behaviors to best meet adolescents' contraceptive needs and desires.
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Affiliation(s)
- C. Emily Hendrick
- Health Disparities Research Scholars Program, Department of Obstetrics & Gynecology—Division of Reproductive & Population Health, School of Medicine and Public Health, University of Wisconsin-Madison, 667 WARF, 610 Walnut Street, Madison, WI 53726
| | - Joshua N. Cone
- Health Behavior & Health Education Program, Department of Kinesiology & Health Education, The University of Texas at Austin, 2109 San Jacinto Blvd., D3700, Austin, TX 78712-1415
| | - Jessica Cirullo
- Health Behavior & Health Education Program, Department of Kinesiology & Health Education, The University of Texas at Austin, 2109 San Jacinto Blvd., D3700, Austin, TX 78712-1415
| | - Julie Maslowsky
- Health Behavior & Health Education Program, Department of Kinesiology & Health Education, The University of Texas at Austin, 2109 San Jacinto Blvd., D3700, Austin, TX 78712-1415
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7
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Abstract
Rates of sexual activity, pregnancies, and births among adolescents have continued to decline during the past decade to historic lows. Despite these positive trends, many adolescents remain at risk for unintended pregnancy and sexually transmitted infections (STIs). This technical report discusses the new data and trends in adolescent sexual behavior and barrier protection use. Since 2017, STI rates have increased and use of barrier methods, specifically external condom use, has declined among adolescents and young adults. Interventions that increase availability of or accessibility to barrier methods are most efficacious when combined with additional individual, small-group, or community-level activities that include messages about safer sex. Continued research informs public health interventions for adolescents that increase the consistent and correct use of barrier methods and promote dual protection of barrier methods for STI prevention together with other effective methods of contraception.
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Affiliation(s)
- Laura K Grubb
- Departments of Pediatrics and Public Health and Community Medicine, Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts
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Onono M, Nanda K, Heller KB, Taylor D, Yacobson I, Heffron R, Kasaro MP, Louw CE, Nhlabasti Z, Palanee-Phillips T, Smit J, Wakhungu I, Gichangi PB, Mugo NR, Morrison C, Baeten JM. Comparison of pregnancy incidence among African women in a randomized trial of intramuscular depot medroxyprogesterone acetate (DMPA-IM), a copper intrauterine device (IUDs) or a levonorgestrel (LNG) implant for contraception. Contracept X 2020; 2:100026. [PMID: 32577615 PMCID: PMC7301167 DOI: 10.1016/j.conx.2020.100026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/14/2020] [Accepted: 05/17/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The objective was to address bias in contraception efficacy studies through a randomized study trial of intramuscular depot medroxyprogesterone acetate (DMPA-IM), a copper intrauterine device (IUDs) and a levonorgestrel (LNG) implant. STUDY DESIGN We analyzed data from the Evidence for Contraceptive Options and HIV Outcomes Trial, which assessed HIV incidence among 7829 women from 12 sites in eSwatini, Kenya, South Africa and Zambia seeking effective contraception and who consented to be randomized to DMPA-IM, copper IUD or LNG implant. We used Cox proportional hazards regression adjusted for condom use to compare pregnancy incidence during both perfect and typical (i.e., allowing temporary interruptions) use. RESULTS A total of 7710 women contributed to this analysis. Seventy pregnancies occurred during perfect and 85 during typical use. There was no statistically significant difference in perfect use pregnancy incidence among the methods: 0.61 per 100 woman-years for DMPA-IM [95% confidence interval (CI) 0.36-0.96], 1.06 for copper IUD (95% CI 0.72-1.50) and 0.63 for LNG implants (95% CI 0.39-0.96). Typical use pregnancy rates were also largely similar: 0.87 per 100 woman-years for DMPA-IM (95% CI 0.58-1.25), 1.11 for copper IUD (95% CI 0.77-1.54) and 0.63 for LNG implants (95% CI 0.39-0.96). CONCLUSIONS In this randomized trial of highly effective contraceptive methods among African women, both perfect and typical use resulted in low pregnancy rates. Our findings provide strong justification for improving access to a broader range of longer-acting contraceptive options including LNG implants and copper IUD for African women. IMPLICATIONS STATEMENT Data from this study support recommendations to providers, policy makers and patients that all of these methods provide safe and highly effective contraception for African women.
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Affiliation(s)
- Maricianah Onono
- Kenya Medical Research Institute Center for Microbiology Research, P.O. Box 19464-00202, Nairobi, Kenya
| | | | | | | | | | | | | | - Cheryl E. Louw
- Madibeng Centre for Research, Brits, South Africa
- Department of Family Medicine, University of Pretoria, Pretoria, South Africa
| | - Zelda Nhlabasti
- Family Life Association of eSwatini & ICAP at Columbia University, eSwatini
| | - Thesla Palanee-Phillips
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, School of Clinical Medicine, Johannesburg, South Africa
| | - Jenni Smit
- University of the Witwatersrand, Durban, South Africa
| | - Imelda Wakhungu
- Kenya Medical Research Institute Center for Microbiology Research, P.O. Box 19464-00202, Nairobi, Kenya
| | - Peter B. Gichangi
- International Center for Reproductive Health, Kenya
- Technical University of Mombasa, Mombasa, Kenya
| | - Nelly R. Mugo
- Kenya Medical Research Institute Center for Microbiology Research, P.O. Box 19464-00202, Nairobi, Kenya
- University of Washington, Seattle, USA
| | | | | | - for the Evidence for Contraceptive Options and HIV Outcomes (ECHO) Trial Consortium
- Kenya Medical Research Institute Center for Microbiology Research, P.O. Box 19464-00202, Nairobi, Kenya
- FHI 360, Durham, USA
- University of Washington, Seattle, USA
- UNC Global Projects Zambia & University of North Carolina at Chapel Hill, Zambia
- Madibeng Centre for Research, Brits, South Africa
- Department of Family Medicine, University of Pretoria, Pretoria, South Africa
- Family Life Association of eSwatini & ICAP at Columbia University, eSwatini
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, School of Clinical Medicine, Johannesburg, South Africa
- University of the Witwatersrand, Durban, South Africa
- International Center for Reproductive Health, Kenya
- Technical University of Mombasa, Mombasa, Kenya
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9
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Chernick LS, Siden JY, Bell DL, Dayan PS. A Qualitative Assessment to Understand the Barriers and Enablers Affecting Contraceptive Use Among Adolescent Male Emergency Department Patients. Am J Mens Health 2020; 13:1557988319825919. [PMID: 30819063 PMCID: PMC6440070 DOI: 10.1177/1557988319825919] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Early fatherhood is common in the United States (U.S.). The emergency department (ED) plays a disproportionate role in serving patients with unmet reproductive and sexual health needs. With 8 million adolescent males visiting U.S. EDs annually, the ED is a potential site to implement interventions to minimize early fatherhood and unintended teenage pregnancy. Little is known about how adolescent male ED patients perceive and behave in sexual relationships and how they influence contraceptive decision making. The objective of this study was to identify the barriers and enablers affecting contraceptive and condom use among adolescent male ED patients. Semistructured interviews were conducted with males aged 14–19 in one urban ED. Enrollment continued until saturation of key themes. Interviews were recorded, transcribed, and coded based on thematic analysis using NVivo 10. The Social Ecological Model was used to organize and understand themes. Participants (n = 24) were predominantly 18–19 years (63%) and Hispanic (92%). Most (71%) had sex ≤3 months prior but infrequently used a condom at last intercourse (42%). The primary barrier influencing contraceptive use was lack of knowledge of effective contraceptives. Other barriers consisted of perceived gender roles, poor partner communication, and little relationship with a primary provider. Enablers included intention not to get a partner pregnant, school-based sexual health education, normalcy to use condoms, and a trustworthy confidante. The identified barriers and enablers influencing adolescent males’ perspectives toward contraceptives should be addressed if designing future ED-based pregnancy prevention interventions targeting teen males.
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Affiliation(s)
- Lauren S Chernick
- 1 Division of Pediatric Emergency Medicine, Department of Emergency Medicine and Pediatrics, Columbia University Medical Center, New York, NY, USA
| | - Jonathan Y Siden
- 1 Division of Pediatric Emergency Medicine, Department of Emergency Medicine and Pediatrics, Columbia University Medical Center, New York, NY, USA
| | - David L Bell
- 2 Department of Population and Family Health, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA.,3 Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
| | - Peter S Dayan
- 1 Division of Pediatric Emergency Medicine, Department of Emergency Medicine and Pediatrics, Columbia University Medical Center, New York, NY, USA
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Dual-Method Contraception Among Adolescents and Young People: Are Long-Acting Reversible Contraception Users Different? A Qualitative Study. J Pediatr Adolesc Gynecol 2020; 33:45-52. [PMID: 31585164 DOI: 10.1016/j.jpag.2019.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 09/09/2019] [Accepted: 09/25/2019] [Indexed: 11/22/2022]
Abstract
STUDY OBJECTIVE The purpose of this study was to understand the factors and influences that affect dual-method contraception in adolescent and young adult women using long-acting reversible contraception (LARC) and whether these are unique to LARC users. DESIGN Qualitative semistructured interview study. SETTING AND PARTICIPANTS Adolescents and young women aged 14-24 years using LARC methods, adolescents and young women aged 14-24 years using short-acting reversible contraception (SARC), and men aged 14-30 years. INTERVENTIONS Interviews were conducted until thematic saturation was reached. MAIN OUTCOME MEASURES The team used a grounded theory approach to identify common themes relating to dual-method contraception. RESULTS Interviews were conducted with 20 LARC users, 26 SARC users, and 13 men. There were no differences in dual-method contraception use between LARC users and SARC users. Most participants used condoms primarily for pregnancy prevention rather than sexually transmitted infection (STI) prevention. Relationship context played an important role in dual-method contraception among all 3 groups; participants were less likely to use condoms in a long-term or monogamous relationship than with new or casual partners. Most participants perceived themselves to be at low risk for STI acquisition, although even those who identified themselves to be at risk did not consistently use condoms. Immediate availability of condoms was a determinant of condom use in all 3 groups, whereas knowledge, access, and negotiation of condom use were not. CONCLUSION LARC users are similar to SARC users in their decision-making about condom use. Relationship factors and STI risk assessment are important components to be included in contraceptive counseling.
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11
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Hoopes AJ, Sucato GS. Long-Acting Reversible Contraceptive Methods Need a Barrier to Prevent Sexually Transmitted Infections in Adolescents. JAMA Pediatr 2019; 173:624-626. [PMID: 31107510 DOI: 10.1001/jamapediatrics.2019.1133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Gina S Sucato
- Adolescent Center, Kaiser Permanente Washington, Seattle.,Kaiser Permanente Washington Health Research Institute, Seattle
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12
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Consistent condom use among highly effective contraceptive users in an HIV-endemic area in rural Kenya. PLoS One 2019; 14:e0216208. [PMID: 31059524 PMCID: PMC6502455 DOI: 10.1371/journal.pone.0216208] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 04/16/2019] [Indexed: 11/26/2022] Open
Abstract
Background Women of reproductive age are at the highest risk of both HIV infection and unintended pregnancy in sub-Saharan Africa. Highly effective contraceptives (HECs) such as hormonal injectable and implants are widely used in this region. HECs are effective for preventing pregnancies. However, unlike condoms, HECs offer no protection against HIV. Dual-method use, or the use of condoms with HECs, is an ideal option to reduce HIV risk but is infrequently practiced. Rather, women tend not to use condoms when they use HECs and increase their HIV risk from their sexual partners. However, it remains unknown whether HIV status affects such tendency. Given the increasing popularity of HECs in sub-Saharan Africa, this study examined the association between the use of HECs and condom use among HIV-positive and negative women. Methods A cross-sectional study was conducted among 833 sexually active women aged 18–49 years, recruited from six clinics in Siaya county, Kenya. From March to May 2017, female research assistants interviewed the women using a structured questionnaire. Multiple logistic regression analysis was conducted to examine the association between HEC use and consistent condom use in the past 90 days, adjusting for potential confounders. It was also examined with regular partners (husbands or live-in partners) and non-regular partners, separately. In addition, a sub-sample analysis of HIV-negative or unknown women was conducted. Results In total, 735 women were available for the analysis. Among the women, 231 (31.4%) were HIV-positive. HIV-positive women were more likely to use HECs than HIV-negative or status unknown women (70.1% vs. 61.7%, p = 0.027). HEC use was significantly associated with decreased condom use with a regular partner (adjusted odds ratio (AOR) = 0.25; 95% CI 0.15–0.43, p<0.001) and a non-regular partner (AOR = 0.25; 95% CI 0.11–0.58, p = 0.001). However, compared with HIV-negative or status unknown women, HIV-positive women were more likely to use HECs and condoms consistently with a regular partner (AOR = 6.54, 95% CI 2.15–20.00, p = 0.001). Other factors significantly associated with consistent condom use included partner’s positive attitude toward contraception, partner’s HIV-positive status, high HIV risk perception, and desire for children in the future. Conclusion Dual-method use was limited among HIV-negative women and women who had HIV-negative partners due to inconsistent condom use. The use of HECs was significantly associated with decreased condom use, regardless of partner type and their HIV status. Due to this inverse association, HIV-negative women may increase their HIV risk from their sexual partners. Therefore, interventions should be strengthened to reduce their dual risks of HIV infection and unintended pregnancy by promoting dual-method use. Family planning services should strengthen counseling on the possible risk of HIV infection from their sexual partners and target not only women but also their partners, who may play a key role in condom use.
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de Looze M, Madkour AS, Huijts T, Moreau N, Currie C. Country-Level Gender Equality and Adolescents' Contraceptive Use in Europe, Canada and Israel: Findings from 33 Countries. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2019; 51:43-53. [PMID: 30817858 PMCID: PMC6996477 DOI: 10.1363/psrh.12090] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 11/21/2018] [Accepted: 11/26/2018] [Indexed: 05/30/2023]
Abstract
CONTEXT Although an association between gender equality and contraceptive use has been confirmed among adult samples, few studies have explored this relationship among adolescents. An examination of whether adolescents' contraceptive use is more prevalent in countries with higher levels of gender equality is needed to fill this gap. METHODS Nationally representative data from 33 countries that participated in the 2013-2014 Health Behaviour in School-Aged Children study and country-level measures of gender equality-using the 2014 Global Gender Gap Index-were analyzed. Multilevel multinomial logistic regression analyses were employed to assess associations between gender equality and contraceptive use (condom only, pill only and dual methods) at last intercourse as reported by 4,071 females and 4,110 males aged 14-16. RESULTS Increasing gender equality was positively associated with contraceptive use among both males and females. For every 0.1-point increase on the equality scale, the likelihood of condom use at last intercourse rose (odds ratio, 2.1 for females), as did the likelihood of pill use (6.5 and 9.6, respectively, for males and females) and dual method use (2.1 and 5.6, respectively). Associations with pill use and dual use remained significant after national wealth and income inequality were controlled for. Overall, associations were stronger for females than for males. CONCLUSIONS More research is needed to identify potential causal pathways and mechanisms through which gender equality and adolescents' contraceptive use may influence one another.
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Affiliation(s)
- Margaretha de Looze
- Assistant professor, Department of Inter disciplinary Social Science, Faculty of Social and Behavioural SciencesUtrecht UniversityUtrechtthe Netherlands
| | - Aubrey S. Madkour
- Associate professor, Department of Global Community Health and Behavioral SciencesTulane University School of Public Health and Tropical MedicineNew Orleans
| | - Tim Huijts
- Researcher, Research Centre for Education and the Labour Market, School of Business and EconomicsMaastricht UniversityMaastrichtthe Netherlands
| | - Nathalie Moreau
- Researcher, Service d'Information Promotion Education Santé, School of Public HealthUniversité Libre de BruxellesBrusselsBelgium
| | - Candace Currie
- Professor, Child and Adolescent Health Research Unit, WHO Collaborating Centre for International Child and Adolescent Health Policy, School of MedicineUniversity of St. AndrewsSt. AndrewsScotland
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Guilamo-Ramos V, Bowman AS, Benzekri A, Ruiz Y, Beltran O. Misalignment of sexual and reproductive health priorities among older Latino adolescents and their mothers. Contraception 2018; 99:179-183. [PMID: 30471265 DOI: 10.1016/j.contraception.2018.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 10/17/2018] [Accepted: 11/14/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The study describes maternal and adolescent perspectives on sexual decision making and the role of mothers in shaping use of contraception for the prevention of unplanned pregnancies and sexually transmitted infections (STIs) among older Latino adolescents. STUDY DESIGN Researchers used a semistructured interview guide to conduct focus group discussions with 21 mother-adolescent Latino dyads (n=42). Latino adolescents ages 17-19 were eligible for the study. We recruited families from the South Bronx, New York City, using area sampling methodology. For analysis of qualitative data, we used the framework method involving open coding, identification of dominant themes, refining of codebooks and indexing. RESULTS Overwhelmingly, results suggest asymmetric priorities and preferences regarding maternal involvement in older adolescent sexual and contraceptive decision making. Mothers primarily employed practices designed to prevent adolescent sexual activity. Most teens reported already having experienced sexual debut and were currently sexually active. Adolescents expressed a strong interest in practical support for sexual decision making, including maternal guidance regarding effective access to and use of contraception. Mothers offered limited guidance or support with such matters. Maternal views focused entirely on the health and social consequences of sex in lieu of specific guidance on contraception for older sexually active adolescents. The findings highlight a missed opportunity for Latino mothers to support their older adolescent children to prevent unplanned pregnancies, STIs and HIV. CONCLUSION Mothers have the potential to positively shape adolescent contraceptive decision making and behavior. Misalignment of priorities between mothers and adolescents diminishes the potential of reducing adolescent sexual and reproductive health (SRH) disparities. IMPLICATIONS Mothers are influential in reducing adolescent SRH risk. However, asymmetric priorities among Latino adolescents and their mothers regarding support for SRH reduce likelihood of reducing adolescent negative SRH outcomes and supporting adolescent health. Programs supporting better alignment of maternal guidance and adolescent SRH needs are warranted.
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Affiliation(s)
- Vincent Guilamo-Ramos
- The Center for Latino Adolescent and Family Health, Silver School of Social Work, New York University, New York, NYU, USA; Adolescent AIDS Program, Children's Hospital at Montefiore Medical Center, Bronx, NY, USA.
| | - Alex S Bowman
- The Center for Latino Adolescent and Family Health, Silver School of Social Work, New York University, New York, NYU, USA; Columbia University, College of Physicians and Surgeons New York, NY, USA
| | - Adam Benzekri
- The Center for Latino Adolescent and Family Health, Silver School of Social Work, New York University, New York, NYU, USA
| | - Yumary Ruiz
- The Center for Latino Adolescent and Family Health, Silver School of Social Work, New York University, New York, NYU, USA; Department of Health and Kinesiology, Perdue University, West Lafayette, IN, USA
| | - Oscar Beltran
- Women's and Gender Studies, University of Texas at El Paso, El Paso, TX, USA
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Dunn S, Xiong AQ, Nuernberger K, Norman WV. Non-use of Contraception by Canadian Youth Aged 15 to 24: Findings From the 2009-2010 Canadian Community Health Survey. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 41:29-37. [PMID: 30316712 DOI: 10.1016/j.jogc.2018.05.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 05/11/2018] [Accepted: 05/15/2018] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Non-use of contraception is an important contributor to unintended pregnancy. This study assessed non-use of contraception and its determinants among Canadian youth aged 15 to 24. METHODS Data from the 2009-2010 Canadian Community Health Survey respondents aged 15 to 24 were used to identify non-users of contraception among heterosexual youth who had had intercourse within the previous 12 months, were not pregnant or sterilized, and felt it was important to avoid pregnancy. Sociodemographic, behavioural, and geographic factors were compared for non-users and users of contraception. RESULTS Among youth at risk for unintended pregnancy, 15.5% were non-users of contraception. There were no differences between sexes. Across regions of Canada, Quebéc had the highest proportion of at-risk youth, but at-risk Quebéc youth were the least likely to be non-users (7.4%; CI 5.7%-9.0%) compared with at-risk youth in the Territories (28.3%; CI 21.6%-35.0%). In the multivariable analysis, aside from residence outside of Quebéc, younger age, lower income, Aboriginal identification (adjusted OR [aOR] 1.67; CI 1.18-2.37), and smoking (aOR 1.55; CI 1.24-1.92) were associated with non-use. Canadian-born youth (aOR 0.61; CI 0.39-0.96) and those enrolled in school (aOR 0.63; CI 0.50-0.81) were less likely to be non-users. CONCLUSION The 15.5% of Canadian youth at risk for unintended pregnancy who were non-users of contraception represent an estimated 300 000 Canadian youth. Policies and programs to promote and support access to sexual health services and effective contraception with specific attention to supporting the needs of younger teens, Aboriginal youth, newcomers, low-income youth, and youth who are not in school are needed.
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Affiliation(s)
- Sheila Dunn
- Department of Family and Community Medicine and Dalla Lana School of Public Health, University of Toronto, Toronto, ON; Women's College Research Institute, Toronto, ON.
| | - An Qi Xiong
- Faculty of Medicine, University of British Columbia, Vancouver, BC
| | - Kim Nuernberger
- Division of Continuing Studies, University of Victoria, Victoria, BC
| | - Wendy V Norman
- Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Family Practice, University of British Columbia, Vancouver, BC
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Satterwhite CL. Comprehensive Adolescent Sexual Health: An Unmet Prevention Need. J Womens Health (Larchmt) 2018; 27:737-738. [DOI: 10.1089/jwh.2018.7042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Catherine L. Satterwhite
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, Kansas
- Department of Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City, Kansas
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17
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Walsh-Buhi ER, Helmy HL. Trends in long-acting reversible contraceptive (LARC) use, LARC use predictors, and dual-method use among a national sample of college women. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2018; 66:225-236. [PMID: 29111911 DOI: 10.1080/07448481.2017.1399397] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Assess long-acting reversible contraceptive (LARC) and other contraceptive use trends, identify LARC use predictors, and examine dual method use. PARTICIPANTS Women in the American College Health Association-National College Health Assessment (ACHA-NCHA) II, aged 18-24 years, who reported having vaginal sex (N = 37,899). METHODS Secondary analyses of Fall 2011-2014 ACHA-NCHA II data. RESULTS Statistically significant increases in LARC usage and, specifically, implant usage, were found. Characteristics associated with LARC use included age, race/ethnicity, relationship status, and school type. Students reporting LARC use had lower odds of condom usage compared with non-LARC hormonal method users. CONCLUSION This analysis of LARC predictors and dual LARC/condom use has implications for research and health promotion efforts. Findings suggest that college health services are well positioned to meet the sexual and reproductive health needs of diverse populations of students. College health professionals should elicit students' individual and/or relationship priorities to tailor messaging/services offered for pregnancy/STI prevention.
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Affiliation(s)
- Eric R Walsh-Buhi
- a Division of Health Promotion and Behavioral Science , Graduate School of Public Health, San Diego State University , San Diego , California , USA
| | - Hannah L Helmy
- b Department of Public Health , Montclair State University , Montclair , New Jersey , USA
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18
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Steiner RJ, Rasberry CN, Sales JM, Gaydos LM, Pazol K, Kramer MR, Swartzendruber A. Do health promotion messages integrate unintended pregnancy and STI prevention? A content analysis of online information for adolescents and young adults. Contraception 2018; 98:S0010-7824(18)30147-1. [PMID: 29684327 PMCID: PMC9125411 DOI: 10.1016/j.contraception.2018.04.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 04/12/2018] [Accepted: 04/16/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Recently there have been calls to strengthen integration of unintended pregnancy and sexually transmitted infection (STI) prevention messages, spurred by increasing use of long-acting reversible contraception. To assess the extent to which public health/clinical messages about unintended pregnancy prevention also address STI prevention, we conducted a content analysis of web-based health promotion information for young people. STUDY DESIGN Websites identified through a systematic Google search were eligible for inclusion if they were operated by a United States-based organization with a mission related to public health/clinical services and the URL included: 1) original content; 2) about sexual and reproductive health; 3) explicitly for adolescents and/or young adults. Using defined protocols, URLs were screened and content was selected and analyzed thematically. RESULTS Many of the 32 eligible websites presented information about pregnancy and STI prevention separately. Concurrent discussion of the two topics was often limited to statements about (1) strategies that can prevent both outcomes (abstinence, condoms only, condoms plus moderately or highly effective contraceptive methods) and (2) contraceptive methods that confer no STI protection. We also identified framing of condom use with moderately or highly effective contraceptive methods for back-up pregnancy prevention but not STI prevention. STI prevention methods in addition to condoms, such as STI/HIV testing, vaccination, or pre-exposure or post-exposure prophylaxis, were typically not addressed with pregnancy prevention information. CONCLUSIONS There may be missed opportunities for promoting STI prevention online in the context of increasing awareness of and access to a full range of contraceptive methods. IMPLICATIONS Strengthening messages that integrate pregnancy and STI prevention may include: describing STI prevention strategies when noting that birth control methods do not prevent STIs; promoting a full complement of STI prevention strategies; and always connecting condom use to STI prevention, even when promoting condoms for back-up contraception.
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Affiliation(s)
- Riley J Steiner
- Centers for Disease Control and Prevention, Division of Adolescent and School Health, 1600 Clifton Road NE, Mailstop E-75, Atlanta, GA 30329, USA; Emory University Rollins School of Public Health, Department of Behavioral Sciences and Health Education, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
| | - Catherine N Rasberry
- Centers for Disease Control and Prevention, Division of Adolescent and School Health, 1600 Clifton Road NE, Mailstop E-75, Atlanta, GA 30329, USA
| | - Jessica M Sales
- Emory University Rollins School of Public Health, Department of Behavioral Sciences and Health Education, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Laura M Gaydos
- Emory University Rollins School of Public Health, Department of Health Policy and Management, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Karen Pazol
- Centers for Disease Control and Prevention, Division of Reproductive Health, 4770 Buford Highway, Mailstop F-74, Atlanta, GA 30341, USA
| | - Michael R Kramer
- Emory University Rollins School of Public Health, Department of Epidemiology, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Andrea Swartzendruber
- University of Georgia College of Public Health, Department of Epidemiology and Biostatistics, 101 Buck Road, Athens, GA 30602, USA
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19
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Coyle KK, Peterson AJ, Franks HM, Anderson PM, Glassman JR. Dual Contraceptive Method Use Among Youth in Alternative Schools. J Prim Prev 2018; 37:561-567. [PMID: 27798719 DOI: 10.1007/s10935-016-0453-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Dual contraceptive method use, or using a highly effective contraceptive method plus a barrier method like condoms, is gaining attention as a strategy for preventing unplanned pregnancy and sexually transmitted diseases. We investigated rates of dual method use among a sample of youth in urban alternative schools, and explored the relationship between dual method use and sexual partner type. The study analyzed data from 765 students enrolled in 11 district-run continuation high schools in northern California. We explored the association between dual method use and sexual partner type (steady only, a mix of steady and non-steady, and non-steady only) using logistic regression. Differences in dual rates by partner type were statistically significant, with higher rates of dual methods use reported among young people reporting non-steady sexual partners only, as compared to those with steady partners only. The data illustrate that young people in alternative school settings could gain from further intervention on the benefits, skills, and challenges of using two methods of contraception as opposed to one with both steady and non-steady sexual partners.
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Affiliation(s)
- Karin K Coyle
- ETR, 100 Enterprise Way, Suite G300, Scotts Valley, CA, 95066, USA.
| | | | - Heather M Franks
- ETR, 100 Enterprise Way, Suite G300, Scotts Valley, CA, 95066, USA
| | | | - Jill R Glassman
- ETR, 100 Enterprise Way, Suite G300, Scotts Valley, CA, 95066, USA
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20
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McNicholas CP, Klugman JB, Zhao Q, Peipert JF. Condom use and incident sexually transmitted infection after initiation of long-acting reversible contraception. Am J Obstet Gynecol 2017; 217:672.e1-672.e6. [PMID: 28919400 PMCID: PMC6262837 DOI: 10.1016/j.ajog.2017.09.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 09/01/2017] [Accepted: 09/07/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Use of more effective contraception may lead to less condom use and increased incidence of sexually transmitted infection. OBJECTIVE The objective of this study was to compare changes in condom use and incidence of sexually transmitted infection acquisition among new initiators of long-acting reversible contraceptives to those initiating non-long-acting reversible contraceptive methods. STUDY DESIGN This is a secondary analysis of the Contraceptive CHOICE Project. We included 2 sample populations of 12-month continuous contraceptive users. The first included users with complete condom data (baseline, and 3, 6, and 12 months) (long-acting reversible contraceptive users: N = 2371; other methods: N = 575). The second included users with 12-month sexually transmitted infection data (long-acting reversible contraceptive users: N = 2102; other methods: N = 592). Self-reported condom use was assessed at baseline and at 3, 6, and 12 months following enrollment. Changes in condom use and incident sexually transmitted infection rates were compared using χ2 tests. Risk factors for sexually transmitted infection acquisition were identified using multivariable logistic regression. RESULTS Few participants in either group reported consistent condom use across all survey time points and with all partners (long-acting reversible contraceptive users: 5.2%; other methods: 11.3%; P < .001). There was no difference in change of condom use at 3, 6, and 12 months compared to baseline condom use regardless of method type (P = .65). A total of 94 incident sexually transmitted infections were documented, with long-acting reversible contraceptive users accounting for a higher proportion (3.9% vs 2.0%; P = .03). Initiation of a long-acting reversible contraceptive method was associated with increased sexually transmitted infection incidence (odds ratio, 2.0; 95% confidence ratio, 1.07-3.72). CONCLUSION Long-acting reversible contraceptive initiators reported lower rates of consistent condom use, but did not demonstrate a change in condom use when compared to preinitiation behaviors. Long-acting reversible contraceptive users were more likely to acquire a sexually transmitted infection in the 12 months following initiation.
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Affiliation(s)
- Colleen P McNicholas
- Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St Louis School of Medicine, St Louis, MO.
| | - Jessica B Klugman
- Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St Louis School of Medicine, St Louis, MO
| | - Qiuhong Zhao
- Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St Louis School of Medicine, St Louis, MO
| | - Jeffrey F Peipert
- Department of Obstetrics and Gynecology; Indiana University School of Medicine, Indianapolis, IN
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21
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Rose SB, Garrett SM, Stanley J, Pullon SRH. Chlamydia testing and diagnosis following initiation of long-acting reversible contraception: A retrospective cohort study. Aust N Z J Obstet Gynaecol 2017; 57:665-675. [PMID: 28832936 DOI: 10.1111/ajo.12685] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 07/10/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Long-acting reversible contraception (LARC) effectively protects against pregnancy but provides no protection against sexually transmitted infections (STIs). AIM To compare rates of chlamydia testing and diagnosis for women initiating long-acting versus oral contraception. MATERIALS AND METHODS Retrospective cohort study involving data collection for 6160 women initiating post-abortion contraception at a large New Zealand regional public hospital abortion clinic (2009-2012), with chlamydia testing data obtained from the local laboratory during two-year follow up. Negative binomial regression modelling examined the effect of contraceptive method on two outcome measures: chlamydia testing and chlamydia diagnosis (adjusting for potential covariates of age, ethnicity, past chlamydia infection, pregnancy history) in year one and two of follow up. RESULTS Two thousand seven hundred and twenty nine women (44%) received a LARC and 1764 (28.6%) were prescribed oral contraception. Adjusted testing rates differed by contraceptive method only in year one (P < 0.01): with higher rates among copper intrauterine device users (relative risk (RR) 1.2, 95% CI 1.06-1.35), and lower rates for implant users (RR 0.84, 95% CI 0.72-0.99) compared with oral contraceptive users (reference group). No significant differences were observed in chlamydia diagnosis rates by contraceptive method (P > 0.05). Younger age, past chlamydia infection, Maori and Pacific ethnicity were associated with higher rates of chlamydia diagnosis (P < 0.01). CONCLUSIONS Known STI-related risk factors (age, ethnicity, past infection) but not contraceptive method were independently related to rates of subsequent chlamydia diagnosis. This suggests that increased LARC uptake would not occur at the expense of chlamydia control. Regular screening and risk reduction advice (including condom use) are important chlamydia control measures for at-risk groups.
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Affiliation(s)
- Sally B Rose
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Susan M Garrett
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - James Stanley
- Biostatistical Group, University of Otago, Wellington, New Zealand
| | - Susan R H Pullon
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
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22
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Kottke M, Hailstorks T. Improvements in Contraception for Adolescents. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2017. [DOI: 10.1007/s13669-017-0214-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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El Ayadi AM, Rocca CH, Kohn JE, Velazquez D, Blum M, Newmann SJ, Harper CC. The impact of an IUD and implant intervention on dual method use among young women: Results from a cluster randomized trial. Prev Med 2017; 94:1-6. [PMID: 27773708 PMCID: PMC6373723 DOI: 10.1016/j.ypmed.2016.10.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 10/13/2016] [Accepted: 10/18/2016] [Indexed: 11/18/2022]
Abstract
Long-acting reversible contraceptives (LARCs) are highly effective at preventing pregnancy but do not protect against sexually transmitted infection (STI). Recent efforts to improve access to intrauterine devices (IUDs) and implants have raised concerns about STI prevention and reduced condom use, particularly among teenagers and young women. We evaluated whether a provider-targeted intervention to increase LARC access negatively impacted dual method use and STI incidence among an at-risk patient population. We conducted a cluster randomized trial in 40 reproductive health centers across the United States from May 2011 to May 2013. After training providers at 20 intervention sites, we recruited 1500 sexually-active women aged 18-25years who did not desire pregnancy and followed them for one year. We assessed intervention effects on dual method use, condom use and STI incidence, modeling dual method use with generalized estimating equations and STI incidence with Cox proportional hazard regression models, accounting for clustering. We found no differences between intervention and control groups in dual method use (14.3% vs. 14.4%, aOR 1.03, 95% CI 0.74-1.44) or condom use (30% vs. 31%, aOR 1.03, 95% CI 0.79-1.35) at last sex at one year. STI incidence was 16.5 per 100 person-years and did not differ between intervention and control groups (aHR 1.20, 95% CI 0.88-1.64). A provider training intervention to increase LARC access neither compromised condom use nor increased STI incidence among young women. Dual method use was very low overall, highlighting the need to bolster STI prevention efforts among adolescents and young women.
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Affiliation(s)
- Alison M El Ayadi
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, United States.
| | - Corinne H Rocca
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, United States
| | - Julia E Kohn
- Planned Parenthood Federation of America, United States
| | | | - Maya Blum
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, United States
| | - Sara J Newmann
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, United States
| | - Cynthia C Harper
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, United States
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Abstract
Adolescents have high rates of unintended pregnancy and face unique reproductive health challenges. Providing confidential contraceptive services to adolescents is important in reducing the rate of unintended pregnancy. Long-acting contraception such as the intrauterine device and contraceptive implant are recommended as first-line contraceptives for adolescents because they are highly effective with few side effects. The use of barrier methods to prevent sexually transmitted infections should be encouraged. Adolescents have limited knowledge of reproductive health and contraceptive options, and their sources of information are often unreliable. Access to contraception is available through a variety of resources that continue to expand.
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Affiliation(s)
- Shandhini Raidoo
- Department of Obstetrics, Gynecology, and Women's Health, Kapiolani Medical Center for Women and Children, University of Hawaii John A. Burns School of Medicine, 1319 Punahou Street, Suite 824, Honolulu, HI 96826, USA.
| | - Bliss Kaneshiro
- Department of Obstetrics, Gynecology, and Women's Health, Kapiolani Medical Center for Women and Children, University of Hawaii John A. Burns School of Medicine, 1319 Punahou Street, Suite 824, Honolulu, HI 96826, USA
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25
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Lantos H, Bajos N, Moreau C. Determinants and Correlates of Preventive Behaviors at First Sex With a First Partner and Second Partner: Analysis of the FECOND Study. J Adolesc Health 2016; 58:644-51. [PMID: 27210009 PMCID: PMC4914384 DOI: 10.1016/j.jadohealth.2016.03.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 01/07/2016] [Accepted: 03/03/2016] [Indexed: 12/01/2022]
Abstract
PURPOSE This study explores transitions in contraceptive use in early sexual life in France and has three objectives: describe predictors of contraceptive use at first sex with first and second partners, describe contraceptive trajectories in these partnerships, and test associations between use at first sex and switching in first partnership on use with second partner. METHODS Our analyses include 1,823 participants, aged 15-29 years, of the 2010 French national sexual health survey who reported at least two lifetime sexual partners and a subset of 1,593 people who report contraceptive use throughout their first partnership. We use logistic regression and generalized estimating equation models to investigate the three objectives. RESULTS Our results reveal a decline in contraceptive use between first and second partner, driven primarily by decreases in condom use, from 87.9% to 79.5% between first and second partner. This is partially offset by an increase in use of effective methods (from 7.8% to 38.1%), particularly by women. Any method use and discontinuation with first partner were predictors of patterns with second partner. CONCLUSIONS Analysis of early transitions in contraceptive use of adolescents in early sexual life reveals shifts from sexually transmitted infection to pregnancy prevention and an increase in unprotected sex.
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Affiliation(s)
- Hannah Lantos
- Child Trends, Bethesda, Maryland; Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
| | | | - Caroline Moreau
- Johns Hopkins University School of Public Health, Department of Population, Family and Reproductive Health
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26
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Hillard PJA. Intrauterine Device Use in Adolescents. J Adolesc Health 2015; 57:359-60. [PMID: 26403839 DOI: 10.1016/j.jadohealth.2015.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 07/29/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Paula J Adams Hillard
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
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Lehti V, Gissler M, Suvisaari J, Manninen M. Induced abortions and birth outcomes of women with a history of severe psychosocial problems in adolescence. Eur Psychiatry 2015; 30:750-5. [PMID: 26117381 DOI: 10.1016/j.eurpsy.2015.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 05/28/2015] [Accepted: 05/29/2015] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To increase knowledge on the reproductive health of women who have been placed in a residential school, a child welfare facility for adolescents with severe psychosocial problems. METHODS All women (n=291) who lived in the Finnish residential schools on the last day of the years 1991, 1996, 2001 and 2006 were included in this study and compared with matched general population controls. Register-based information on induced abortions and births was collected until the end of the year 2011. RESULTS Compared to controls, women with a residential school history had more induced abortions. A higher proportion of their births took place when they were teenagers or even minors. They were more often single, smoked significantly more during pregnancy and had a higher risk of having a preterm birth or a baby with a low birth weight. CONCLUSIONS The findings have implications for the planning of preventive and supportive interventions that aim to increase the well-being of women with a residential school history and their offspring.
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Affiliation(s)
- V Lehti
- Department of Psychiatry, Helsinki University Central Hospital, P.O. Box 442, 00029 HUS, Finland.
| | - M Gissler
- National Institute for Health and Welfare (THL), Department of Information Services, P.O. Box 30, 00271 Helsinki, Finland; Nordic School of Public Health, Gothenburg, Sweden
| | - J Suvisaari
- National Institute for Health and Welfare (THL), Mental Health Unit, P.O. Box 30, 00271 Helsinki, Finland
| | - M Manninen
- National Institute for Health and Welfare (THL), Mental Health Unit, P.O. Box 30, 00271 Helsinki, Finland
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Effects of initiating a contraceptive implant on subsequent condom use: A randomized controlled trial. Contraception 2015; 92:560-6. [PMID: 26079469 DOI: 10.1016/j.contraception.2015.06.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 06/04/2015] [Accepted: 06/08/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate whether initiation of a contraceptive implant, a method of long-acting reversible contraception, reduces condom use, as measured by a biomarker of recent semen exposure [prostate-specific antigen (PSA)]. STUDY DESIGN We conducted a randomized controlled clinical trial in which 414 Jamaican women at high risk for sexually transmitted infections (STIs) attending family planning clinics received the contraceptive implant at baseline ("immediate" insertion arm, N=208) or at the end ("delayed" insertion arm, N=206) of a 3-month study period. Participants were tested for PSA at baseline and two follow-up study visits and were asked about their sexual activity and condom use. RESULTS At baseline, 24.9% of women tested positive for PSA. At both follow-up visits, the prevalence of PSA detection did not significantly differ between the immediate versus delayed insertion arm [1-month: 26.1% vs. 20.2%, prevalence ratio (PR)=1.3, 95% confidence interval (CI)=0.9-1.9; 3-month: 25.6% vs. 23.1%, PR= 1.1, 95% CI=0.8-1.6]. The change in PSA positivity over the three study visits was not significantly larger in the immediate arm compared to the delayed arm (1-sided p-value of .15). CONCLUSIONS Contraceptive implants can be successfully introduced into a population at high risk of unintended pregnancy and STIs without a biologically detectable difference in unprotected sex in the short term. This information strengthens the evidence to support promotion of implants in such populations and can help refine counseling for promoting and maintaining use of condoms among women who choose to use implants. IMPLICATIONS Sex unprotected by a condom was not higher over 3 months in women receiving a contraceptive implant, compared with those not receiving the implant.
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Abstract
This study aims to establish the prevalence of risky health behaviors among Thai youth and to characterize the prevalence of these behaviors by gender, age group, educational status, and region. We analyzed data from a population-based, nationally representative, cross-sectional survey of 938 youth aged between 13 and 24 years, sampled from Bangkok and 4 regions of Thailand. The 2011 Youth Risk Behavior Surveillance System questionnaire was used to measure youth risk behaviors. This study finds that 15.9% of respondents had engaged in physical fights, and 8.1% had been cyber bullied. The prevalence of current cigarette smoking, alcohol, and marijuana use were 22.3%, 27.9%, and 2.3%, respectively. The prevalence of risky behaviors among Thai youth were found to be high, including behaviors that contribute to unintentional injuries and violence, unsafe sexual behaviors, and cigarette and alcohol consumption.
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Walsh JL, Fielder RL, Carey KB, Carey MP. Dual method use among a sample of first-year college women. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2014; 46:73-81. [PMID: 24684480 PMCID: PMC4201449 DOI: 10.1363/46e1014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
CONTEXT Dual method use-using one protective method to reduce the risk of STDs and another to prevent pregnancy-is effective but understudied. No prior studies have employed an event-level approach to examining characteristics associated with dual method use among college women. METHODS In 12 consecutive monthly surveys conducted in 2009-2010, data on 1,843 vaginal intercourse events were collected from 296 first-year college women. Women reported on their use of condoms and hormonal contraceptives during all events. Multilevel regression analysis was used to assess associations between event-, month- and person-level characteristics and hormonal use and dual method use. RESULTS Women used hormonal contraceptives during 53% of events and condoms during 63%. Dual method use was reported 28% of the time, and only 14% of participants were consistent users of dual methods. The likelihood of dual method use was elevated when sex partners were friends as opposed to romantic partners or ex-boyfriends (odds ratios, 2.5-2.8), and among women who had received an STD diagnosis prior to college (coefficient, 2.9); it also increased with level of religiosity (0.8). Dual use was less likely when less reliable methods were used (odds ratio, 0.2) and when women reported more months of hormonal use (0.8), were older than 18 (coefficient, -4.7) and had had a greater number of partners before college (-0.3). CONCLUSIONS A better understanding of the characteristics associated with dual method use may help in the design of potential intervention efforts.
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Affiliation(s)
- Jennifer L. Walsh
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence; and Department of Psychiatry and Human Behavior, Alpert Medical School, and Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence
| | - Robyn L. Fielder
- Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY
| | - Kate B. Carey
- Department of Behavioral and Social Sciences, Program in Public Health, and Center for Alcohol and Addiction Studies, Brown University
| | - Michael P. Carey
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence; and Department of Psychiatry and Human Behavior, Alpert Medical School, and Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence
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Hillard PJA. What Is LARC? And why does it matter for adolescents and young adults? J Adolesc Health 2013; 52:S1-5. [PMID: 23535051 DOI: 10.1016/j.jadohealth.2013.02.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 02/01/2013] [Indexed: 01/13/2023]
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