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Rendall MS, Eeckhaut MCW, Gifford K, Hurtado-Acuna C. Long-Acting Reversible Contraception (LARC) and Early Childbearing Revisited: Births and Birth Intendedness After LARC Removal in a State Medicaid Population (2012-2020). Am J Public Health 2024:e1-e8. [PMID: 39388674 DOI: 10.2105/ajph.2024.307844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2024]
Abstract
Objectives. To analyze births and birth intendedness after long-acting reversible contraception (LARC) removal among Medicaid-insured women. Methods. We linked all Delaware women with a Medicaid-covered LARC removal in 2012 to 2020 (n = 8047) to birth records and to Pregnancy Risk Assessment Monitoring System (PRAMS) pregnancy intendedness survey responses (n = 241). Results. Births within 3 years of a Medicaid-covered LARC removal were much more likely to be to women in their 20s compared with all Medicaid births (63.5% vs 53.4%; P < .001). The intended proportion for births within 3 years of Medicaid-covered LARC removal (65.2%) was higher than for all Medicaid-covered births (58.8%; P = .08) and was consistently above 60% across all age groups younger than 30 years. Conclusions. A state Medicaid-insured population's use of highly effective reversible contraception was associated with births being concentrated among women in their 20s and with consistently high fractions of intended births across younger ages at birth. Public Health Implications. Programs and policies may consider LARC access for its potential to increase low-income women's reproductive autonomy by enhancing their ability to achieve births at the age of their choosing. (Am J Public Health. Published online ahead of print October 10, 2024:e1-e8. https://doi.org/10.2105/AJPH.2024.307844).
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Affiliation(s)
- Michael S Rendall
- Michael S. Rendall and Constanza Hurtado-Acuna are with the Department of Sociology and the Maryland Population Research Center, University of Maryland, College Park. Mieke C. W. Eeckhaut is with the Department of Sociology and Criminal Justice, University of Delaware, Newark. Katie Gifford is with the Center for Community Research & Service, University of Delaware, Newark
| | - Mieke C W Eeckhaut
- Michael S. Rendall and Constanza Hurtado-Acuna are with the Department of Sociology and the Maryland Population Research Center, University of Maryland, College Park. Mieke C. W. Eeckhaut is with the Department of Sociology and Criminal Justice, University of Delaware, Newark. Katie Gifford is with the Center for Community Research & Service, University of Delaware, Newark
| | - Katie Gifford
- Michael S. Rendall and Constanza Hurtado-Acuna are with the Department of Sociology and the Maryland Population Research Center, University of Maryland, College Park. Mieke C. W. Eeckhaut is with the Department of Sociology and Criminal Justice, University of Delaware, Newark. Katie Gifford is with the Center for Community Research & Service, University of Delaware, Newark
| | - Constanza Hurtado-Acuna
- Michael S. Rendall and Constanza Hurtado-Acuna are with the Department of Sociology and the Maryland Population Research Center, University of Maryland, College Park. Mieke C. W. Eeckhaut is with the Department of Sociology and Criminal Justice, University of Delaware, Newark. Katie Gifford is with the Center for Community Research & Service, University of Delaware, Newark
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Capobianco G, Sanna E, Gulotta A, Virdis G, Dessole F, Maida I, Madonia M, Cudoni F, Petrillo M. Use of etonogestrel subcutaneous implant in Sardinia, Italy: women's compliance and satisfaction. EUR J CONTRACEP REPR 2024; 29:171-176. [PMID: 38785129 DOI: 10.1080/13625187.2024.2354248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 05/04/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE OF THE ARTICLE The main aim of the study was to analyze the population of women who used etonogestrel implant, the reason that led them to this type of contraception, and the degree of compliance with it. Materials and methods: We carried out a retrospective study on women who had etonogestrel subcutaneous implant placed (n°47) over a 6-year period (2015-2021). We submitted the women a series of questions by telephone questionnaire (range 10-72 months after placements, mean 40 months) that investigated the comorbidities and side effects related to etonogestrel implant. MATERIALS AND METHODS We carried out a retrospective study on women who had etonogestrel subcutaneous implant placed (n°47) over a 6-year period (2015-2021). We submitted the women a series of questions by telephone questionnaire (range 10-72 months after placements, mean 40 months) that investigated the comorbidities and side effects related to etonogestrel implant. RESULTS The average age of placement of etonogestrel implant was 33.8 ± 3.45 years. As regards level of education, 16/47 (34%) of the women had a university degree, 21/47 (44%) had a high school diploma and 10/47 (21%) had a secondary school diploma. The 12/47 (25%) of the women were, at the time of the counselling, unemployed and only 8% did not use in the past contraceptive methods other than etonogestrel implant. The 92% of women choose etonogestrel implant because it offered safe, comfortable and long-lasting contraception. Among the main side effects evaluated, we reported spotting in 24 out of 47 (51%), headache in 4 out of 47 (8.5%). The 85% of the women recommended etonogestrel implant to their friends as a contraceptive method, with an approval rating for the implant, expressed a rating from 1 to 10 with the mean that was 7.79, the median 8. CONCLUSIONS Our results are of interest because they derive from a region of Italy in which the Long acting reversible contraception (LARC) is strongly underused. Etonogestrel implant was a safe and effective, long-acting, reversible hormonal contraception (LARC) and majority of women recommended the etonogestrel implant to their friends as a contraceptive method.
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Affiliation(s)
- Giampiero Capobianco
- Gynecologic and Obstetric Clinic, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Elisa Sanna
- Gynecologic and Obstetric Clinic, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Alessandra Gulotta
- Gynecologic and Obstetric Clinic, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Giuseppe Virdis
- Gynecologic and Obstetric Clinic, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Francesco Dessole
- Gynecologic and Obstetric Clinic, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Ivana Maida
- Institute of Infection diseases, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Massimo Madonia
- Institute of Urology, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Francesco Cudoni
- Orthopedic and Traumatological Center, University-Hospital, Sassari Italy
| | - Marco Petrillo
- Gynecologic and Obstetric Clinic, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
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Asdell SM, Bennett RD, Cordon SA, Zhao Q, Peipert JF. Knowledge and intention to use long-acting reversible contraception among university students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024; 72:1655-1658. [PMID: 35737977 PMCID: PMC9780399 DOI: 10.1080/07448481.2022.2089043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 12/16/2021] [Accepted: 03/27/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To assess the relationship between knowledge of long-acting reversible contraception (LARC) and intention to use LARC among female students. PARTICIPANTS Participants consisted of a convenience sample of 292 female undergraduate and graduate students at a large midwestern university. METHODS We conducted a cross-sectional in-person survey and multivariate analysis of LARC knowledge and intention to use LARC. RESULTS Total response rate was 84.9%. Among contraceptive users, 13.3% were using a LARC method. On average, respondents scored 4.8/10 (SD 2.5) on a 10-item LARC knowledge assessment. Higher levels of LARC knowledge were associated with the intent to use LARC in the future in our multivariate analysis (RR 1.7, 95% CI 1.14-2.54: p = .01). Common reasons for LARC hesitancy were a need for more information, safety concerns, and risk of undesirable side effects. CONCLUSIONS Low LARC knowledge and students' self-identified need for further LARC information represent an opportunity for campus contraceptive interventions which empower students to make informed reproductive decisions.
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Affiliation(s)
| | | | - Sabrina A. Cordon
- Indiana University School of Medicine Department of Obstetrics and Gynecology, Indianapolis, USA
| | - Qiuhong Zhao
- Indiana University School of Medicine Department of Obstetrics and Gynecology, Indianapolis, USA
| | - Jeffrey F. Peipert
- Indiana University School of Medicine Department of Obstetrics and Gynecology, Indianapolis, USA
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Marthey D, Rochford H, Andreyeva E. Examining the impact of Medicaid payments for immediate postpartum long-acting reversible contraception on the mental health of low-income mothers. Health Serv Res 2024; 59:e14281. [PMID: 38205665 PMCID: PMC11063096 DOI: 10.1111/1475-6773.14281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVE To examine the effect of Medicaid immediate postpartum long-acting reversible contraception (IPP LARC) reforms on self-reported mental health among low-income mothers aged 18-44 years. DATA SOURCES AND STUDY SETTING We used national secondary data on self-reported mental health status in the past 30 days from the core component (2014-2019) of the Behavioral Risk Factor Surveillance System (BRFSS). STUDY DESIGN We estimated linear probability models for reporting any days of not good mental health in the past 30 days. We adjusted for individual-level factors, state-level factors, and state and year fixed effects. Our primary independent variable was an indicator for IPP LARC payment reform. We examined the effect of the Medicaid payment reforms on self-reported mental health status in the past 30 days using difference-in-differences and event-study designs. DATA COLLECTION/EXTRACTION METHODS Not applicable. PRINCIPAL FINDINGS State adoption of Medicaid IPP LARC reforms was associated with significant reductions (between 5.7% and 11.5%) in the predicted probability of reporting any days of not good mental health among low-income mothers. Treatment effects appeared to be driven by respondents reporting two or more children (less than 18 years of age) in the household (ATT = -0.028, p = 0.04). Results are robust to a series of sensitivity tests and alternative estimation strategies. CONCLUSIONS Our findings suggest that contemporary efforts to improve access to contraceptive methods may have important benefits beyond reproductive autonomy. These findings have implications for policymakers as the landscape related to family planning services continues to shift.
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Affiliation(s)
- Daniel Marthey
- Department of Health Policy and ManagementTexas A&M UniversityCollege StationTexasUSA
| | - Hannah Rochford
- Department of Health Policy and ManagementTexas A&M UniversityCollege StationTexasUSA
| | - Elena Andreyeva
- Department of Health Policy and ManagementTexas A&M UniversityCollege StationTexasUSA
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Castro A, Lardone MC, Giraudo F, López P, Ortiz E, Iñiguez G, Cassorla F, Codner E. Differential Effect of 2 Hormonal Contraceptives on the Relative Telomere Length of Youth With Type 1 Diabetes. J Endocr Soc 2024; 8:bvae091. [PMID: 38883396 PMCID: PMC11179291 DOI: 10.1210/jendso/bvae091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Indexed: 06/18/2024] Open
Abstract
Context Adolescents and young women (AYA) with type 1 diabetes (T1D) may require hormonal contraception for an extended period. However, it is unclear what effect hormonal contraception has on telomere length, a marker of the risk for complications. Objective To investigate the relative telomere length (RTL) in AYA with T1D (AYA-T1D) and healthy young women (AYA-C) after 18 months of combined oral contraception use (COC) with ethinyl estradiol/desogestrel, or a subdermal etonogestrel implant (IM). Methods A nonrandomized prospective study was performed in which 39 AYA-T1D and 40 AYA-C chose the COC or the IM. RTL was measured by monochrome multiplex-quantitative PCR in DNA from peripheral blood mononuclear cells (PBMC). The impact of contraceptives and clinical variables on RTL was assessed using lineal regression analysis. Results Longer RTL compared to baseline was observed in AYA-T1D (P < .05) and AYA-C (P < .01) after using the IM. However, the total of AYA and the AYA-C group treated with COC decreased RTL after 18 months of treatment compared to baseline (P < .05). The type of contraceptive used was determinant for the changes in RTL compared to baseline in all subjects and controls (P ≤ .006). For AYA-T1D, HbA1c levels were not associated with RTL, but the high-sensitivity C-reactive protein was negatively related with the changes in RTL at 18 months compared to baseline (standardized R2 : 0.230, P = .003). Conclusion IM was associated with longer RTL in AYA-T1D and AYA-C. In contrast, a shortening of telomere length in PBMC was observed after using COC.
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Affiliation(s)
- Andrea Castro
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago 8360160, Chile
| | - M Cecilia Lardone
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago 8360160, Chile
| | - Franco Giraudo
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago 8360160, Chile
- Hospital Clínico San Borja Arriarán, Servicio de Salud Metropolitano Central, Santiago 8360160, Chile
| | - Patricia López
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago 8360160, Chile
- Hospital Clínico San Borja Arriarán, Servicio de Salud Metropolitano Central, Santiago 8360160, Chile
| | - Eliana Ortiz
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago 8360160, Chile
| | - Germán Iñiguez
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago 8360160, Chile
| | - Fernando Cassorla
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago 8360160, Chile
| | - Ethel Codner
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago 8360160, Chile
- Centro de Investigación Clínica Aplicada (CICA), School of Medicine, University of Chile, Santiago, Chile
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Wise MK, Okuyemi O, Flint M, Biscaye EM, Martins SL, Tessier KM, Traxler SA, Boraas CM. Intrauterine Device Placement Success for Adolescents and Young Adults at Community-Based Reproductive Health Clinics. J Pediatr Adolesc Gynecol 2024; 37:160-164. [PMID: 38072035 PMCID: PMC10994767 DOI: 10.1016/j.jpag.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/11/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Despite the endorsement of intrauterine device (IUD) use in adolescents and young adults (AYAs) by leading professional organizations and demonstrated acceptance and desirability by AYAs, clinicians may worry about the procedural difficulty of IUD device placement in younger patients. OBJECTIVE The aim of this study was to evaluate the clinical outcomes of first-attempt IUD placement in an AYA population by vaginal delivery (VD) history. STUDY DESIGN We performed a retrospective cohort study of patients under 25 years old at reproductive health clinics with an IUD placement attempt between January 1 and August 31, 2017. We abstracted sociodemographic characteristics, pregnancy history, and procedural characteristics including complications. Bivariate analyses compared successful first-attempt IUD placement by VD history. We also assessed the frequency of secondary clinical outcomes including ancillary measures used, provider type, symptoms reported during the procedure, and complications. RESULTS We included 1325 participants (median age = 21.3 years), including 42 (3.2%) with a previous VD. Nearly all IUD placements were successful on the first attempt (n = 1301, 98.2%) and performed by advanced practice clinicians (n = 1314, 99.2%). First-attempt IUD placement success was similar in those participants with and without VD (P > .999). Ancillary measures other than nonsteroidal anti-inflammatory drugs were used infrequently (n = 16, 3.6%). Among participants with an unsuccessful placement, 66.7% returned, and all had a successful IUD placement on the second attempt. Documented complications within 6 months of placement were rare (n = 29) and mostly comprised expulsions (n = 27, 93.1%). CONCLUSION IUD placement success among AYAs at community-based reproductive health clinics is high and is not associated with a history of VD.
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Affiliation(s)
- Meredith K Wise
- University of Minnesota Department of Obstetrics, Gynecology and Women's Health, Minneapolis, Minnesota.
| | | | - Maggie Flint
- University of Minnesota Medical School, Minneapolis, Minnesota
| | - Emily M Biscaye
- University of Minnesota Department of Obstetrics, Gynecology and Women's Health, Minneapolis, Minnesota
| | - Summer L Martins
- University of Minnesota Department of Obstetrics, Gynecology and Women's Health, Minneapolis, Minnesota
| | - Katelyn M Tessier
- University of Minnesota Masonic Cancer Center, Biostatistics Core, Minneapolis, Minnesota
| | - Sarah A Traxler
- Planned Parenthood North Central States, St. Paul, Minnesota
| | - Christy M Boraas
- University of Minnesota Department of Obstetrics, Gynecology and Women's Health, Minneapolis, Minnesota
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Tevendale HD, Garraza LG, Brooks MAM, Koumans EH, House LD, Sommerfeldt HM, Brittain A, Mueller T, Fuller TR, Romero L, Fasula A, Warner L. Effects of Community-Wide Teen Pregnancy Prevention Initiatives on Local Teen Birth Rates in the United States: A Synthetic Control Approach. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:545-565. [PMID: 38578374 DOI: 10.1007/s11121-024-01663-0] [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] [Accepted: 02/29/2024] [Indexed: 04/06/2024]
Abstract
The impact of community-wide teen pregnancy prevention initiatives (CWIs) on local U.S. birth rates among adolescents aged 15 to 19 years was examined using synthetic control methodology within a quasi-experimental design. CWIs were implemented in 10 U.S. communities from 2010 to 2015. Each initiative implemented evidence-based teen pregnancy prevention interventions at local organizations and enhanced best practices in adolescent reproductive health care at local health centers, while engaging diverse community sectors. The synthetic control method was used to estimate the impact of each CWI on overall and race- and ethnicity-specific teen births relative to rates in synthetic control communities. Additionally, we estimated the overall effect of CWIs across communities by pooling results from the 10 synthetic control case studies using the mean percentile rank. Pooled data across all 10 communities indicated an estimated average of 6.6 fewer births per 1000 teens per year overall during the initiative relative to each community's synthetic control (p = .001). By race and ethnicity, there were an estimated average of 6.4 fewer births per 1000 teens per year among Black teens (p = .03), 10.7 fewer births among Hispanic teens (p = .03), and 4.2 fewer births (p = .10) among White teens. Results from individual communities indicated an intervention effect on overall and/or race/ethnicity-specific teen birth rates in five communities. This study demonstrates the value of synthetic control methods in evaluating community-level outcomes of programmatic efforts. Findings indicate the CWIs had a positive impact on teen birth rates and have the potential to address racial and ethnic disparities in those rates.
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Affiliation(s)
- Heather D Tevendale
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, 30341, USA.
| | | | | | - Emilia H Koumans
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, 30341, USA
| | - L Duane House
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, 30341, USA
| | | | - Anna Brittain
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, 30341, USA
| | - Trisha Mueller
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, 30341, USA
| | - Taleria R Fuller
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, 30341, USA
| | - Lisa Romero
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, 30341, USA
| | - Amy Fasula
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, 30341, USA
| | - Lee Warner
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, 30341, USA
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Giraudo F, Salinas A, Merino PM, Iñiguez G, López P, Castro A, Lardone MC, Cavada G, Cassorla F, Codner E. Subdermal Progestin Implant and an Oral Combined Hormonal Contraceptive in Youth with Type 1 Diabetes. J Pediatr Adolesc Gynecol 2024; 37:177-183. [PMID: 38012981 DOI: 10.1016/j.jpag.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 11/06/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023]
Abstract
STUDY OBJECTIVE To determine the metabolic effects of the subcutaneous etonogestrel implant compared with an oral contraceptive in adolescents and young adults (AYAs) with type 1 diabetes (T1D) on body weight, body composition, glucose, lipids, and C-reactive protein levels. METHODS This was a non-randomized, interventional, prospective study. Thirty-nine AYAs with T1D participated; 20 used the implant (Implant-T1D), and 19 used an oral combined contraceptive (OC-T1D). Body composition, HbA1c, intermittent continuous glucose monitoring, lipids, and high-sensitivity C-reactive protein (hsCRP) levels were evaluated. RESULTS All participants were followed for at least 12 months, and 26 completed the 24-month follow-up. No women discontinued the intervention due to adverse effects. Body weight increased by 0.8 ± 3.5 and 1 ± 2.9 kg in the OC-T1D and the Implant-T1D group at 12 months and by 2.6 ± 3.9 and 3.3 ± 3.6 kg at 24 months, respectively. OC-T1D and Implant-T1D had similar HbA1c, mean interstitial glucose levels, and time in range throughout the study; no significant difference over time was observed. hsCRP levels increased in both groups and were associated with BMI and HbA1c (P < .001 for both variables). Women in the OC-T1D group had higher total cholesterol, HDL-C, and triglyceride levels compared with the Implant-T1D. CONCLUSION Glucose levels were similar in youth using the subdermal progestin implant and an OC. However, both AYA groups showed increased BMI, fat mass, and subclinical inflammation. Changes in lipid levels were associated with the OC method. These data highlight the importance of weight gain prevention in young women with T1D using hormonal contraception.
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Affiliation(s)
- Franco Giraudo
- Institute of Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile, 8360160; Clinical Hospital San Borja Arriarán, Santiago, Chile, 8360160
| | - Abril Salinas
- Institute of Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile, 8360160; Chilean Institute of Reproductive Medicine (ICMER), Santiago, Chile, 8320165
| | - Paulina M Merino
- Institute of Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile, 8360160; Clinical Hospital San Borja Arriarán, Santiago, Chile, 8360160
| | - Germán Iñiguez
- Institute of Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile, 8360160
| | - Patricia López
- Institute of Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile, 8360160; Clinical Hospital San Borja Arriarán, Santiago, Chile, 8360160
| | - Andrea Castro
- Institute of Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile, 8360160
| | - María Cecilia Lardone
- Institute of Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile, 8360160
| | - Gabriel Cavada
- Public Health, School of Medicine, University of Chile, Santiago, Chile, 8380453
| | - Fernando Cassorla
- Institute of Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile, 8360160
| | - Ethel Codner
- Institute of Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile, 8360160.
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Marmett B, Guaranha DDFK, Carvalho AFD, Reis JM, Souza CLED, Dalcin TC, Amantéa SL. Cost Savings and Effectiveness of Long-Acting Reversible Contraception (LARC) on the Prevention of Pregnancy in Adolescents: A Systematic Review. J Pediatr Adolesc Gynecol 2024; 37:11-17. [PMID: 37802383 DOI: 10.1016/j.jpag.2023.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/14/2023] [Accepted: 09/15/2023] [Indexed: 10/10/2023]
Abstract
Adolescent pregnancy is a major public health issue with profound implications for health and socioeconomic factors. The use of long-acting reversible contraception (LARC) could be an interesting strategy to reduce the unintended pregnancy rate. However, the cost of LARC is still a barrier to widespread adoption. This study aimed to analyze the effectiveness and economic impact of LARC compared with non-LARC methods in preventing unintended pregnancy among adolescent girls. This systematic review was registered in PROSPERO (CRD42023387735) and conducted following the PRISMA guidelines. We included articles covering adolescents aged 10-19 years without language restrictions that evaluated the use of LARC compared with non-LARC in terms of effectiveness and the public health costs of unintended pregnancy. The search for articles included the databases MEDLINE/PubMed, Cochrane Library, Embase, and Lilacs, using the entry terms "Adolescent" and "Long-Acting Reversible Contraception." We evaluated the risk of bias and the certainty of the evidence for each outcome of interest. The search retrieved a total of 1,169 articles and, after the title and abstract, we identified 40 articles for full-text analysis. Out of the 40 studies evaluated, 4 articles met the eligibility criteria for cost evaluation, and 1 met the eligibility criteria for effectiveness as an outcome. In conclusion, LARC emerges as the most effective and cost-effective contraceptive method. The cost of utilizing LARC, especially the copper IUD, is significantly lower than the costs attributable to unintended pregnancies in adolescence.
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Affiliation(s)
- Bruna Marmett
- Escritório de Projetos, Hospital Moinhos de Vento - Program for Institutional Development of the Brazilian Unified Health System (PROADI-SUS) - Brazilian Ministry of Health, Brazil.
| | - Daniela Dal Forno Kinalski Guaranha
- Escritório de Projetos, Hospital Moinhos de Vento - Program for Institutional Development of the Brazilian Unified Health System (PROADI-SUS) - Brazilian Ministry of Health, Brazil
| | - Amanda Ferreira de Carvalho
- Escritório de Projetos, Hospital Moinhos de Vento - Program for Institutional Development of the Brazilian Unified Health System (PROADI-SUS) - Brazilian Ministry of Health, Brazil
| | - Júlia Mathias Reis
- Escritório de Projetos, Hospital Moinhos de Vento - Program for Institutional Development of the Brazilian Unified Health System (PROADI-SUS) - Brazilian Ministry of Health, Brazil
| | - Carmem Lisiane Escouto de Souza
- Escritório de Projetos, Hospital Moinhos de Vento - Program for Institutional Development of the Brazilian Unified Health System (PROADI-SUS) - Brazilian Ministry of Health, Brazil
| | - Tiago Chagas Dalcin
- Escritório de Projetos, Hospital Moinhos de Vento - Program for Institutional Development of the Brazilian Unified Health System (PROADI-SUS) - Brazilian Ministry of Health, Brazil
| | - Sérgio Luís Amantéa
- Escritório de Projetos, Hospital Moinhos de Vento - Program for Institutional Development of the Brazilian Unified Health System (PROADI-SUS) - Brazilian Ministry of Health, Brazil
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Hoffman ND, Alderman EM. Long-Acting Reversible Etonogestrel Subdermal Implant in Adolescents. Pediatr Rev 2024; 45:3-13. [PMID: 38161157 DOI: 10.1542/pir.2022-005685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Several effective contraceptive options are available for use by adolescents, including the long-acting reversible subdermal implant and intrauterine devices, which provide a high level of convenience, privacy, and effectiveness for an adolescent. Knowledge of all the effective birth control methods is essential for the pediatrician to be able to provide effective contraceptive counseling for an adolescent. An approach to counseling using a reproductive justice framework, which allows the provider and adolescent patient to engage in shared decision-making, is described. This article focuses on the long-acting reversible etonogestrel (ENG) subdermal implant for adolescents. The ENG implant is labeled for preventing pregnancy by suppressing ovulation. The ENG implant may also have a role in ameliorating dysmenorrhea and heavy menstrual bleeding. Postlabeling studies indicate that the ENG implant is effective for up to 5 years, although the device's labeling states effectivenessup to 3 years. The main contraindication to using the ENG implant is pregnancy itself. Safe initiation of the ENG implant is described, including an approach to determine whether an adolescent is pregnant. The main adverse effect of the ENG implant is an unpredictable bleeding pattern that is most often ameliorated by use of nonsteroidal anti-inflammatory medications, as well as estrogen, if not contraindicated for the patient. Details of the insertion and removal procedures, including potential complications, are described to enable the pediatrician to provide effective anticipatory guidance for the adolescent.
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Affiliation(s)
- Neal D Hoffman
- Children's Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, NY
| | - Elizabeth M Alderman
- Children's Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, NY
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11
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Adebola OG, Ewemooje OS, Adebola FB. Predictors and differences in fertility level among Nigerian women of reproductive age: a function of subgroup social norms fertility behaviour. HUM FERTIL 2023; 26:1114-1128. [PMID: 36369930 DOI: 10.1080/14647273.2022.2137859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 04/20/2022] [Indexed: 11/15/2022]
Abstract
Fertility rates in Nigeria are declining at such a modest rate, that if more proactive measures are not employed to reduce fertility, the nation may double its population before long. We empirically examined fertility behaviour as derivatives of specific subgroup social norms, and the variations in the factors responsible for different fertility behaviours, using the 2018 Nigeria Demographic and Health Survey. Descriptive bivariate, and multinomial logistic regression analyses were used to predict the contribution of demographic and sociocultural factors contributing to the fertility level, and findings were reported as odds ratios. Results revealed that age, religion and level of education are the most significant predictors of fertility level, with remarkable differences in birth rate across subgroups, whereas North-West Nigeria had the highest fertility level. Furthermore, marriage had a significantly negative effect on high fertility among North-Western women, whereas higher education significantly increased high fertility among North-Eastern women. In conclusion, subgroup social norms fertility behaviour is responsible for the persistent fertility differential outcome in Nigeria. Thus, the paper strongly advocates the need to intensify community-led, norm-based solution and not a universal approach in addressing fertility control in Nigeria.
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Affiliation(s)
| | - Olusegun Sunday Ewemooje
- Department of Statistics, Federal University of Technology, Akure, Nigeria
- Department of Statistics, University of Botswana, Gaborone, Botswana
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Bruce KH, Merchant MA, Kaskowitz AP, Mickelsen RS, Lau JS. Adolescent Long-Acting Reversible Contraceptive Use, Same-Day Insertions, and Pregnancies Following a Quality Initiative. J Adolesc Health 2023; 73:946-952. [PMID: 37436353 DOI: 10.1016/j.jadohealth.2023.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 05/28/2023] [Accepted: 06/01/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVE To compare long-acting reversible contraceptive (LARC) use, pregnancy rate, and same-day LARC insertion among adolescents before and after a Kaiser Permanente Northern California quality initiative. METHODS A 2016 Kaiser Permanente Northern California initiative aimed to increase adolescent LARC access. Interventions included patient education resources, electronic protocols, and insertion training for pediatric, family medicine, and gynecology providers. This study examined a retrospective cohort of adolescents aged 15-18 years who used contraception before (2014-2015, n = 30,094) and after (2017-2018, n = 28,710) implementation. Contraceptive types included LARC (intrauterine device or implant), injectable, and contraceptive pill, patch, or ring. We reviewed a random sample of LARC users (n = 726) to identify same-day insertions. Multivariable analysis examined the effects of year of provision, age, race, ethnicity, LARC type, and counseling clinic. RESULTS Preintervention, 12.1% of adolescents used LARC, 13.6% used injectable, and 74.3% used pill, patch, or ring. Postintervention, the proportions were 23.0%, 11.6%, and 65.4%, respectively, with the odds of LARC provision of 2.57 (95% confidence interval (CI) 2.44-2.72). The pregnancy rate decreased from 2.2% to 1.4% (p < .0001). Higher rates of pregnancy were observed with injectable contraception and in Black and Hispanic adolescents. Same-day LARC insertion rate was 25.1% without significant variation post intervention (OR 1.44, 95% confidence interval 0.93-2.23). Contraceptive counseling in gynecology clinics increased the odds of same-day provision, while non-Hispanic Black race lowered odds. DISCUSSION A multifaceted quality intervention was associated with a 90% increase in LARC use and a 36% decrease in teenage pregnancy rate. Future directions may include promoting same-day insertions, targeting interventions in pediatric clinics, and focusing on racial equity.
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Affiliation(s)
- Kelly H Bruce
- Department of Obstetrics and Gynecology, Kaiser Permanente Santa Clara Medical Center, Santa Clara, California
| | - Maqdooda A Merchant
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Alexa P Kaskowitz
- Division of Pediatric and Adolescent Gynecology, Kaiser Permanente Santa Clara Medical Center, Santa Clara, California
| | - Riley S Mickelsen
- Department of Obstetrics and Gynecology, Kaiser Permanente Santa Clara Medical Center, Santa Clara, California
| | - Josephine S Lau
- Division of Adolescent Medicine, Kaiser Permanente San Leandro Medical Center, San Leandro, California.
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13
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Araújo FG, Abreu MNS, Felisbino-Mendes MS. [Contraceptive mix and factors associated with the type of method used by Brazilian women: a population-based cross-sectional study]. CAD SAUDE PUBLICA 2023; 39:e00229322. [PMID: 37820236 PMCID: PMC10566557 DOI: 10.1590/0102-311xpt229322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 05/16/2023] [Accepted: 06/02/2023] [Indexed: 10/13/2023] Open
Abstract
This study aims to describe the contraceptive mix and analyze the factors associated with the type of contraceptive used by Brazilian women of reproductive age. This is a cross-sectional, population-based study with data from 19,962 women aged 15 to 49 years. The outcomes were use and type of contraceptive, classified as: short-acting reversible contraceptives (SARC), long-acting (LARC), and permanent. The explanatory variables were characteristics of reproductive history, sociodemographic history, and access to health services. Multinomial logistic regression was used for odds ratio (OR) estimates, with SARC being the reference category. The analyses were performed in the Survey module of the Stata software, which considered the effect of the complex sampling plan of the 2019 Brazilian National Health Survey. The prevalence of contraceptive use was 83.7%. Of the total number of users, 72% used SARC, 23.2% permanent methods, and 4.8% LARC. Women with higher education, health insurance, who had deliveries, and who participated in reproductive planning groups had a higher chance of using LARC when compared with the use of SARC, while registration at the basic health unit was associated with a lower chance of use. Still, the higher the age and parity, in addition to living with the partner, the greater the chance of using permanent methods in relation to the use of SARC. Despite the high coverage of contraception, the contraceptive mix remains obsolete, with a predominance of the use of SARC. In addition, important inequalities in access were observed, with LARC being accessible only to women with better socioeconomic conditions, while permanent methods were associated with a profile of greater social vulnerability.
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Poehling C, Downey MM, Gwan AP, Cannady S, Ismail O. How Can We Address What We Do Not Measure? A Systematic Scoping Review of the Measurement and Operationalization of Social Determinants of Health Research on Long-Acting Reversible Contraceptive among Adolescents in the US. ADOLESCENTS (BASEL, SWITZERLAND) 2023; 3:240-258. [PMID: 38912095 PMCID: PMC11192542 DOI: 10.3390/adolescents3020018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
Teen pregnancy is often considered an adverse health outcome that accentuates gender inequities, diminishes opportunities, and jeopardizes the safety of adolescent and young adult birthing people. Long-Acting Reversible Contraceptives (LARC) have been hailed as a panacea for teen pregnancy. However, adolescents and emerging adults intersect with multiple assaults on their health and well-being due to gender inequity and racism. To establish equitable care, it is imperative to discern all barriers that influence their reproductive autonomy. This study evaluates the measurement, operationalization, and quality of research conducted on adolescents and emerging adults that analyzed the use of LARC within the social determinant of health framework (SDOH) in the US. SDOH were assessed using the Dahlgren and Whitehead model, and reports were analyzed using a modified version of the Joanna Briggs Institute (JBI) Critical Appraisal tools. Nineteen articles were included in this study. Researchers found the insufficient measurement of race, ethnicity, sexuality, and gender among studies on LARC and SDOH in adolescents and emerging adults. Future studies must measure a full range of identities in data collection to generate knowledge on the impact of SDOH and LARC use among diverse populations.
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Affiliation(s)
- Catherine Poehling
- School of Social Work, University of Southern Mississippi, Hattiesburg, MS 39401, USA
| | | | - Anwei Polly Gwan
- Department of Obstetrics, Gynecology and Women’s Health, University of Minnesota, Minneapolis, MN 55455, USA
| | | | - Olivia Ismail
- School of Social Work, University of Southern Mississippi, Hattiesburg, MS 39401, USA
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15
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Krass P, Sieke EH, Joshi P, Akers AY, Wood SM. Pediatric Resident Perspectives on Long-Acting Reversible Contraception Training: A Cross-Sectional Survey of Accreditation Council for Graduate Medical Education Trainees. J Adolesc Health 2023; 72:964-971. [PMID: 36907801 PMCID: PMC10198905 DOI: 10.1016/j.jadohealth.2023.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 01/07/2023] [Accepted: 01/09/2023] [Indexed: 03/14/2023]
Abstract
PURPOSE Although pediatricians are primary care providers for most adolescents, pediatric residents receive limited training on long-acting reversible contraceptive (LARC) methods. This study aimed to characterize pediatric resident comfort with placing contraceptive implants and intrauterine devices (IUDs) and assess pediatric resident interest in obtaining this training. METHODS Pediatric residents in the United States were invited to participate in a survey assessing comfort with LARC methods and interest in LARC training during pediatric residency. Bivariate comparisons used Chi-square and Wilcoxon rank sum testing. Multivariate logistic regression was used to assess associations between primary outcomes and covariates including geographic region, training level, and career plans. RESULTS Six hundred twenty seven pediatric residents across the United States completed the survey. Participants were predominantly female (68.4%, n = 429), self-identified their race as White (66.1%, n = 412), and anticipated a career in a subspecialty other than Adolescent Medicine (53.0%, n = 326). Most residents were confident counseling patients on the risks and benefits, side effects, and effective use of contraceptive implants (55.6%, n = 344) and both hormonal and nonhormonal IUDs (53.0%, n = 324). Few residents reported comfort with inserting contraceptive implants (13.6%, n = 84) or IUDs (6.3%, n = 39), with most of these respondents having learned these skills as a medical student. Most participants believed that residents should receive training on insertion of contraceptive implants (72.3%, n = 447) and IUDs (62.5%, n = 374). DISCUSSION Although most pediatric residents believe LARC training should be a component of pediatric residency training, few pediatric residents are comfortable with provision of this care.
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Affiliation(s)
- Polina Krass
- Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Erin H Sieke
- Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Priyanka Joshi
- Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Sarah M Wood
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadephia, Pennsylvania
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16
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Durante JC, Sims J, Jarin J, Gold MA, Messiah SE, Francis JKR. Long-Acting Reversible Contraception for Adolescents: A Review of Practices to Support Better Communication, Counseling, and Adherence. Adolesc Health Med Ther 2023; 14:97-114. [PMID: 37181329 PMCID: PMC10167958 DOI: 10.2147/ahmt.s374268] [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: 01/31/2023] [Accepted: 04/12/2023] [Indexed: 05/16/2023] Open
Abstract
Long-acting reversible contraception (LARC) methods, including levonorgestrel and copper intrauterine devices (IUDs) and the subdermal contraceptive implant, are the most effective reversible forms of contraception and thus are an important aspect of adolescent pregnancy prevention. While LARC efficacy, safety, and appropriateness are supported by major medical organizations and usage rates are increasing, overall LARC uptake among United States (US) adolescents remains lower than uptake of short-acting contraceptive methods. A better understanding of the barriers affecting adolescent LARC uptake and reasons for discontinuation could help facilitate effective communication. For example, learning how to improve adolescent-centered communication, shared decision-making, and motivational counseling strategies may be the first step to improving utilization rates. This narrative review includes three sections. First, this review will describe the history, mechanisms of action, and epidemiology of adolescent LARC use in the US and globally. Next, this review will describe key factors influencing adolescent LARC uptake, reasons for discontinuation, and multilevel barriers specific to adolescent LARC use. Finally, this review will characterize communication techniques and LARC counseling strategies for adolescents in the context of a reproductive justice approach set in the health belief model framework. The distinction between moving away from a presumptive counseling approach towards an adolescent-centered, shared decision-making approach to encourage parent-adolescent sexual health communication to lay the foundation of empowering adolescent reproductive autonomy should be the underpinning of all effective reproductive communication strategies.
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Affiliation(s)
- Julia C Durante
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Children’s Health System of Texas, Dallas, TX, USA
| | - Jessica Sims
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Children’s Health System of Texas, Dallas, TX, USA
| | - Jason Jarin
- Children’s Health System of Texas, Dallas, TX, USA
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Melanie A Gold
- Department of Pediatrics and Department of Population & Family Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Sarah E Messiah
- University of Texas Health Science Center at Houston, School of Public Health, Dallas Campus, Dallas, TX, USA
- Center for Pediatric and Population Health, UTHealth School of Public Health, Dallas, TX, USA
- Department of Pediatrics, McGovern Medical School, Houston, TX, USA
| | - Jenny K R Francis
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Children’s Health System of Texas, Dallas, TX, USA
- Peter O’Donnell School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
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17
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Early pregnancy confirmation availability at crisis pregnancy centers and abortion facilities in the United States. Contraception 2023; 117:30-35. [PMID: 36084711 DOI: 10.1016/j.contraception.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Crisis pregnancy centers (CPCs) seek to dissuade people from having abortions. Twenty-five states have policies supporting CPCs. We aimed: (1) to characterize access to early pregnancy confirmation at CPCs compared to abortion facilities nationwide and (2) to understand the role of state CPC policy in service access. STUDY DESIGN We conducted a national mystery caller study of 445 CPCs and geographically paired abortion facilities, posing as patients seeking pregnancy confirmation. Facility type (CPC vs abortion facility) was the primary exposure in Aim 1. Wait time to first available early pregnancy appointment was the primary outcome. In Aim 2, state-level CPC policy designation (supportive vs not supportive of CPCs) was the primary exposure. Difference in wait time ≥7 days to first available appointment between CPCs and paired abortion facilities was the primary outcome. RESULTS CPCs were more likely than abortion facilities to provide same-day appointments (68.5% vs 37.2%, p < 0.0001), and free pregnancy testing (98.0% vs 16.6%, p < 0.0001). The median wait to first available appointment at a CPC was 0 days (IQR 0,1), compared to 1 day at abortion facilities (IQR 0, 5), p < 0.0001. In states with supportive CPC policy environments, abortion facilities were less likely to have wait times exceeding their paired CPC by a week or more, compared to paired facilities in states with non-supportive CPC policy environments (p = 0.033). This remained true after adjusting for state abortion policy environment (p = 0.011). CONCLUSIONS Pregnancy confirmation is more accessible at CPCs compared to abortion facilities. Factors other than state-level CPC policies likely influence service accessibility. There is a need for improved access to pregnancy confirmation in medical settings. IMPLICATIONS Our findings demonstrating that pregnancy confirmation is more accessible at crisis pregnancy centers than at abortion facilities are predicted to be exacerbated in the wake of abortion clinic closures following the Dobbs v Jackson Women's Health Organization Supreme Court decision. This highlights the need for improved funding and support for pregnancy confirmation service delivery in medical settings, including abortion facilities.
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Garmi G, Seh-Shmali K, Zafran N, Erez O, Romano S, Salim R. Efficacy and safety of intrauterine device placement during a planned cesarean section. Heliyon 2022; 8:e12318. [PMID: 36582683 PMCID: PMC9793275 DOI: 10.1016/j.heliyon.2022.e12318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/12/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
Objective Approximately 79% of pregnancies conceived within the first year after delivery are unintended and 50% of the couples report having unprotected intercourse before the first routine postpartum appointment. Unintended pregnancies are associated with unsafe abortions and other poor outcomes. We aimed to determine the efficacy and safety of intrauterine device (IUD) placement during a planned cesarean section (CS) at one year after insertion. Study Design A survey-based retrospective cohort study conducted at a university teaching hospital. The study cohort included term pregnant women delivered by a planned CS between December 2016 and July 2020, and data collection and questionnaires were completed in July 2021. In the study group, copper or Levonorgestrel IUDs were placed through the uterine incision after delivery of the fetus and placenta, while women in the control group did not receive an IUD. Other perioperative managements were similar. The primary outcome was unintended pregnancy rate during the first year after delivery. Results The study comprised a total of 150 women, with 50 and 100 in the study and control groups, respectively. None of the women in the study group became pregnant, compared with nine (9%) in the controls (p = 0.03), of them eight (88.9%) were unplanned. Perioperative outcome was comparable between groups. The rate of contraceptive use one year after delivery was significantly higher in the study group compared to the control group (86.0% vs. 35.0%, respectively, p < 0.001). Conclusion IUD placement during CS is effective in preventing unintended pregnancies within the first year after delivery, with operative outcomes unaffected. Implications Intrauterine device (IUD) placement during a planned cesarean section prevented unintended pregnancies within one year after birth. Additionally, the rate of contraceptive use at one year was significantly higher compared to women who elected not to have an IUD inserted during the cesarean. IUD placement did not affect perioperative outcomes.
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Affiliation(s)
- Gali Garmi
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel,The Ruth and Bruce Rappaport, Faculty of Medicine, Technion, Haifa, Israel
| | - Khadeje Seh-Shmali
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
| | - Noah Zafran
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel,The Ruth and Bruce Rappaport, Faculty of Medicine, Technion, Haifa, Israel
| | - Offer Erez
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel,Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
| | - Shabtai Romano
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel,The Ruth and Bruce Rappaport, Faculty of Medicine, Technion, Haifa, Israel
| | - Raed Salim
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel,The Ruth and Bruce Rappaport, Faculty of Medicine, Technion, Haifa, Israel,Corresponding author.
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Perez M, Chambers S, Ceballos V, Kelley A, Hettema J, Sussman A, Kosnick S, Moralez-Norris E, Jackson S, Baca M. Informed Contraceptive Decisions: A Qualitative Study of Hispanic Teens in New Mexico. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2022; 3:982-989. [PMID: 36636318 PMCID: PMC9811835 DOI: 10.1089/whr.2022.0070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/24/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES U.S. Hispanic teens experience higher rates of unintended pregnancy than white teens. Limited research has been done to explore the sociocultural factors that impact Hispanic teens and their decisions about birth control and long-acting reversible contraception (LARC). The theory of planned behavior served as a framework for this study and teen perspectives about contraceptive decision making. This study aimed to identify the sociocultural factors that impact Hispanic teens when they make decisions about birth control and LARC. STUDY DESIGN AND METHODS We interviewed Hispanic teens from school-based health centers in New Mexico during their schedule medical appointments. Interviews were audio recorded, transcribed, and coded using content analysis coding methods and a descriptive qualitative design. RESULTS A total of 20 Hispanic teens participated in this study, all were female and between the ages of 14 and 19 years. THEMES Five themes emerged from the analysis process that impact Hispanic teen contraceptive choice, these are family, religion, culture, peer influence, and other factors. CONCLUSIONS AND IMPLICATIONS Among both LARC and non-LARC groups, peer influence was the most frequently cited reason for contraceptive decision making. Relationships with family were cited as barriers for Hispanic teens, where lack of communication and abstinence-only beliefs made it difficult to seek contraception. Findings demonstrate that teens selected LARCs because of the impacts on menstrual cycles and clinician influence. Teens who did not self-select LARC discussed ease of protection and the utilization of birth control as a transition to LARC.
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Affiliation(s)
- Mayra Perez
- Community Health Work Initiatives, University of New Mexico, Health Sciences Center, Albuquerque, New Mexico, USA
| | - Stephanie Chambers
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | - Venice Ceballos
- Community Health Work Initiatives, University of New Mexico, Health Sciences Center, Albuquerque, New Mexico, USA
| | - Allyson Kelley
- Allyson Kelley & Associates PLLC, Albuquerque, New Mexico, USA
| | | | - Andrew Sussman
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | | | | | - Samantha Jackson
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | - Melanie Baca
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico, USA
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20
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De Silva DA, Gleason JL. Affordable Care Act (ACA) Implementation and Adolescent Births by Insurance Type: An Interrupted Time Series Analysis of Births between 2009 and 2017 in the United States. J Pediatr Adolesc Gynecol 2022; 35:685-691. [PMID: 35820607 DOI: 10.1016/j.jpag.2022.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 06/22/2022] [Accepted: 07/05/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND In 2010, the Affordable Care Act (ACA) was enacted, with full provisions in effect by 2014, including expanded Medicaid coverage, changes to the marketplace, and contraceptive coverage, but its impact on birth trends, particularly adolescent births, is currently unknown. OBJECTIVES We sought to determine whether ACA implementation was associated with changes in adolescent births and whether this differed by insurance type (Medicaid or private insurance). METHODS We used revised 2009-2017 birth certificate data, restricted to resident women with a Medicaid or privately paid singleton birth (N = 27,748,028). Segmented regression analysis was used to examine births to adolescent mothers (12-19 years old) before and after the ACA. RESULTS There were 27,748,028 singleton births (n = 2,013,521 adolescent births) among U.S. residents between 2009 and 2017 in this analytic sample. Adjusted models revealed that the ACA was associated with a 23% significant decrease in odds of an adolescent birth (OR = 0.78; 95% CI, 0.77-0.79) for Medicaid-funded births and a 19% decrease (OR = 0.81; 95% CI, 0.79-0.83) for privately insured births, with a further declining trend. Overall declines in adolescent births among the Medicaid population appear to be driven by states that chose to expand Medicaid. CONCLUSION Beyond the declining secular trend already observed in adolescent pregnancy over the last 10 years, the ACA appears to have had a substantial impact on adolescent births, likely due to Medicaid expansion and increased access to affordable contraception. From a population health perspective, efforts to undo the ACA could have important consequences for maternal, infant, and family health in the United States.
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Affiliation(s)
- Dane A De Silva
- Department of Family Science, School of Public Health, University of Maryland, College Park, MD, United States.
| | - Jessica L Gleason
- Department of Family Science, School of Public Health, University of Maryland, College Park, MD, United States
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21
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Wilkinson TA, Hawryluk B, Moore C, Peipert JF, Carroll AE, Wiehe S, Fortenberry JD. A human-centered designed outreach strategy for a youth contraception navigator program. PEC INNOVATION 2022; 1:100093. [PMID: 36540664 PMCID: PMC9762731 DOI: 10.1016/j.pecinn.2022.100093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 10/17/2022] [Accepted: 10/17/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To identify key elements of an outreach strategy for a youth contraception navigator program designed to help young people overcome barriers to contraception access. METHODS A human-centered design approach was used to engage adolescents aged 15-17 in co-design sessions. Human-centered design techniques, such as affinity diagramming and model building were used to inform key elements of the communication model and the final outreach strategy messages. RESULTS Messages focused on the individual, normalizing talking about birth control, acknowledging the challenges to obtaining birth control, explaining how the navigator program works resonate with young people. Having images of diverse participants, offering information about birth control, and showing images of reputable sources will enhance trust. CONCLUSIONS A name (IN Control) and key elements of an outreach strategy were determined for the navigator program. It is important to work with key stakeholders and co-design the optimal strategy and messages to assure that the intended audience is reached, and the desired behavior change is achieved. INNOVATION Human-centered design techniques can be used to provide insight into programmatic outreach strategies for a contraception navigator program to increase their impact and ultimate success.
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Affiliation(s)
- Tracey A. Wilkinson
- Indiana University School of Medicine, Department of Pediatrics/Children's Health Services Research, 410 West 10 Street, HS 2000, Indianapolis, IN 46202, United States of America
| | - Bridget Hawryluk
- Indiana Clinical Translational Institute, Research Jam, 410 West 10 Street, HS 2000, Indianapolis, IN 46202, United States of America
| | - Courtney Moore
- Indiana Clinical Translational Institute, Research Jam, 410 West 10 Street, HS 2000, Indianapolis, IN 46202, United States of America
| | - Jeffrey F. Peipert
- Indiana University School of Medicine, Department of Obstetrics and Gynecology, UH 2440, Indianapolis, IN 46202, United States of America
| | - Aaron E. Carroll
- Indiana University School of Medicine, Department of Pediatrics/Center for Pediatric and Adolescent Comparative and Effective Research, 410 West 10 Street, HS 2000A, Indianapolis, IN 46202, United States of America
| | - Sarah Wiehe
- Indiana University School of Medicine, Department of Pediatrics/Children's Health Services Research, 410 West 10 Street, HS 2000, Indianapolis, IN 46202, United States of America
- Indiana Clinical Translational Institute, Research Jam, 410 West 10 Street, HS 2000, Indianapolis, IN 46202, United States of America
| | - J. Dennis Fortenberry
- Indiana University School of Medicine, Department of Pediatrics, Division of Adolescent Medicine, 410 West 10 Street, HS 1000, Indianapolis, IN 46202, United States of America
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22
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Prevalence and risk factors for female and male adolescents involved in pregnancy and abortion: a population-based cross-sectional study in Taiwan, 2006–2016. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-022-01772-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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23
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Gregory JW, Cameron FJ, Joshi K, Eiswirth M, Garrett C, Garvey K, Agarwal S, Codner E. ISPAD Clinical Practice Consensus Guidelines 2022: Diabetes in adolescence. Pediatr Diabetes 2022; 23:857-871. [PMID: 36250644 PMCID: PMC9828225 DOI: 10.1111/pedi.13408] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 01/12/2023] Open
Affiliation(s)
- John W. Gregory
- Division of Population Medicine, School of MedicineCardiff UniversityCardiffUK
| | - Fergus J. Cameron
- Royal Children's HospitalMelbourneAustralia,Murdoch Children's Research InstituteMelbourneAustralia,Department of PaediatricsUniversity of MelbourneMelbourneAustralia
| | - Kriti Joshi
- Department of Endocrinology & DiabetesQueensland Children's HospitalSouth BrisbaneAustralia
| | - Mirjam Eiswirth
- Department of Anglophone StudiesUniversität Duisburg EssenEssenGermany
| | - Christopher Garrett
- Institute of Psychiatry, Psychology and NeuroscienceBart's Health and East London Foundation TrustLondonUK
| | - Katharine Garvey
- Division of EndocrinologyBoston Children's HospitalBostonMassachusettsUSA
| | - Shivani Agarwal
- Department of Medicine (Endocrinology), Albert Einstein College of MedicineMontefiore Medical CenterBronxNew YorkUSA
| | - Ethel Codner
- Instituto de Investigaciones Materno Infantil, Facultad de MedicinaUniversity of ChileSantiagoChile
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24
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Шайдуллина МР, Валеева ФВ, Субханкулова АФ, Хусиева ПА. [Contraception in adolescents with obesity and diabetes mellitus]. PROBLEMY ENDOKRINOLOGII 2022; 68:137-145. [PMID: 36689719 PMCID: PMC9939967 DOI: 10.14341/probl12760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/01/2022] [Accepted: 08/10/2022] [Indexed: 01/25/2023]
Abstract
Today most adolescents have their first sexual experience at the age of 15-19. However, only 44% of girls and young women (15-24 years old) report about contraception at that moment. A decision on pregnancy in adolescence is a difficult choice and any scenario may cause serious medical and social problems. Complications after an artificial abortion have a negative impact on a woman's fertility. Diabetes mellitus type 1 and arterial hypertension accompanied with obesity within the metabolic syndrome are defined by the World Health Organization (WHO) as diseases, which increase risk of an unplanned pregnancy. The article consoders problems of interaction of a doctor and a teenage girl with endocrinopathy, when discussing her sexual health, the analysis of the literature reflecting the influence of contraception on the course of the underlying pathology is presented. The authors formed a list of drugs acceptable for use in diabetes and obesity based on assessment of risks and preferences from the use of different methods of fertility control. The work contains information about the procedure of starting contraception, the rules of future dynamic monitoring of the patient.
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Affiliation(s)
- М. Р. Шайдуллина
- Казанский государственный медицинский университет; Детская республиканская клиническая больница
| | | | | | - П. А. Хусиева
- ГАУЗ «Детская республиканская клиническая больница» Минздрава Республики Татарстан
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25
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Wilkinson TA, Hawryluk B, Moore C, Peipert JF, Carroll AE, Wiehe S, Fortenberry JD. Developing a Youth Contraception Navigator Program: A Human-Centered Design Approach. J Adolesc Health 2022; 71:217-225. [PMID: 35562301 PMCID: PMC9329236 DOI: 10.1016/j.jadohealth.2022.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 03/03/2022] [Accepted: 03/03/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To determine key elements of a contraception navigator program that provides a personalized approach to overcoming patient-specific barriers by a trained navigator in central Indiana. METHODS A human-centered design approach was used to engage adolescents and community stakeholders in co-design sessions. Sessions incorporated techniques, such as divergent brainwriting and journey maps, which led to the exploration of various themes that were ultimately used to inform key elements of the contraception navigator program. RESULTS Adolescents aged 15-17 years (N = 35) and community stakeholders (N = 11) participated in co-design sessions. Analysis verified that the process of obtaining contraception for pregnancy prevention could be intimidating for young people. The importance of language, the presence of stigma, and the knowledge of side effects were all discussed. Essential elements of a contraceptive navigator program included building trust to ultimately co-create a plan that can overcome patient-specific barriers. Having a variety of communication methods available, as well as contraceptive side-effect support, will be essential. DISCUSSION Using human-centered design techniques to engage adolescent and community stakeholders can help inform the development of a contraceptive navigator program. A trusted navigator that can address patient-specific barriers to contraception access both before and after contraception is obtained is a key element identified by stakeholders.
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Affiliation(s)
- Tracey A. Wilkinson
- Indiana University School of Medicine, Department of Pediatrics/Children’s Health Services Research, 410 West 10th Street, HS 2000, Indianapolis, IN. 46202
| | - Bridget Hawryluk
- Indiana Clinical Translational Institute, Research Jam, 410 West 10th Street, HS 2000, Indianapolis, IN. 46202
| | - Courtney Moore
- Indiana Clinical Translational Institute, Research Jam, 410 West 10th Street, HS 2000, Indianapolis, IN. 46202
| | - Jeffrey F. Peipert
- Indiana University School of Medicine, Department of Obstetrics and Gynecology, UH 2440, Indianapolis, IN. 46202
| | - Aaron E. Carroll
- Indiana University School of Medicine, Department of Pediatrics/Center for Pediatric and Adolescent Comparative and Effective Research, 410 West 10th Street, HS 2000A, Indianapolis, IN. 46202
| | - Sarah Wiehe
- Indiana University School of Medicine, Department of Pediatrics/Children’s Health Services Research, 410 West 10th Street, HS 2000, Indianapolis, IN. 46202
| | - J. Dennis Fortenberry
- Indiana University School of Medicine, Department of Pediatrics, Division of Adolescent Medicine, 410 West 10th Street, HS 1000, Indianapolis, IN. 46202
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26
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Inthavong S, Pantasri T, Morakote N, Muangmool T, Piyamongkol W, Pongsatha S, Chaovisitseree S. Change of contraceptive preference after the free-LARC program for Thai teenagers. BMC Womens Health 2022; 22:211. [PMID: 35672692 PMCID: PMC9172104 DOI: 10.1186/s12905-022-01797-9] [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: 01/19/2022] [Accepted: 05/23/2022] [Indexed: 11/21/2022] Open
Abstract
Background In 2014, the Thai government launched a free-of-charge long-acting reversible contraception (LARC) program for Thai female adolescents. However, its acceptance had not been reported. Therefore, this study aimed to describe contraceptive use among women of reproductive age before and after the program was implemented. Methods This retrospective cross-sectional study was carried out from the medical records of 9000 women of reproductive age, who attended the Family Planning Clinic at Maharaj Nakorn Chiang Mai Hospital between 2009 and 2018. The Chi-square test was used to compare the contraceptive methods administered before and after the program was implemented, and binary logistic regression was used to find the factors associated with implant use after completion of the program. Results Depot medroxy progesterone acetate (DMPA) injection was the most popular contraceptive method used among 40.9% of the women. The rates of subdermal implant use were increased significantly after the program was implemented (2.3–9.3%, p < 0.001). Implant use for adolescents aged less than 20 years increased from 2.6% to 56.4%, while DMPA was the most popular method used among adult women at 36.4%. Factors associated significantly with implant use after implement of the program included age of less than 20 years (aOR = 4.17 (CI: 1.84–9.44); p = 0.001) and nulliparity (aOR = 8.55 (CI: 3.77–19.39); p < 0.001). Conclusion This study showed a significant increase in contraceptive implant use after the free-LARC program for adolescents had been applied. Statement of implications Contraceptive implant is the most effective hormonal reversible contraception. Its use rate is low among all age groups, but increased clearly after the free-of-charge program was applied for adolescents.
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Affiliation(s)
- Sathaphone Inthavong
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Tawiwan Pantasri
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
| | - Nuntana Morakote
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Tanarat Muangmool
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Wirawit Piyamongkol
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Saipin Pongsatha
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Somsak Chaovisitseree
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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27
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Reed SD, Zhou X, Ichikawa L, Gatz JL, Peipert JF, Armstrong MA, Raine-Bennett T, Getahun D, Fassett MJ, Postlethwaite DA, Shi JM, Asiimwe A, Pisa F, Schoendorf J, Saltus CW, Anthony MS. Intrauterine device-related uterine perforation incidence and risk (APEX-IUD): a large multisite cohort study. Lancet 2022; 399:2103-2112. [PMID: 35658995 DOI: 10.1016/s0140-6736(22)00015-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 12/28/2021] [Accepted: 01/04/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND Reports of perforation risk related to intrauterine devices (IUDs) inserted immediately post partum and among non-post-partum individuals are scarce, and previous studies with only 12-month follow-ups underestimate the risk. Breastfeeding at IUD insertion and insertion within 36 weeks post partum have been associated with increased risk of uterine perforation. The aim of these analyses was to compare the incidence and risks of IUD-related uterine perforations by non-post-partum and post-partum intervals at IUD insertion, and among post-partum individuals, to assess the impact of breastfeeding on these outcomes. METHODS We did a multisite cohort study in the USA, using electronic health records (EHR). Study sites were three health-care systems and a site that used data from a health-care information exchange. The study population included individuals who were aged 50 years or younger and had an IUD insertion between Jan 1, 2001, and April 30, 2018. Individuals were excluded if they had not been in the health-care system for at least 12 months before IUD insertion. The primary outcome for this analysis was any IUD-related uterine perforation diagnosis for the first IUD insertion in this time period. Both complete and partial IUD-related perforations were identified. Chart abstraction was done to validate EHR-based algorithms or confirm perforations. The crude rate and cumulative incidence of uterine perforation were evaluated by non-post-partum and post-partum intervals at IUD insertion in the full cohort, and by breastfeeding status in a subcohort of post-partum individuals. Cox models estimated crude and adjusted hazard ratios (aHRs). FINDINGS Data from 326 658 individuals in the full cohort and 94 817 individuals in the post-partum subcohort were analysed. In the full cohort, we identified 1008 uterine perforations (51·2% complete), with the 5-year cumulative incidence being the lowest in the non-post-partum group (0·29%, 95% CI 0·26-0·34). The aHR for the post-partum interval relative to non-post partum ranged from 2·73 (95% CI 1·33-5·63; 0 to 3 days post partum) to 6·71 (4·80-9·38; 4 days to ≤6 weeks post partum). The post-partum subcohort of individuals with breastfeeding information had 673 uterine perforations (62% complete), with a 5-year cumulative incidence of 1·37% (95% CI 1·24-1·52) and an increased risk with breastfeeding (aHR 1·37, 95% CI 1·12-1·66). INTERPRETATION Although the risk for uterine perforation with IUD insertion 4 days to 6 weeks or less post partum is nearly seven times that of insertion non-post partum, perforation remains an incredibly rare event for all clinical time points. Despite a slight increased risk of perforation with breastfeeding at IUD insertion, the benefits of breastfeeding and effective contraception generally outweigh risks and should have little clinical impact. Therefore, IUD insertion timing should be based on individual desire for IUD contraception and patient convenience to assure an IUD insertion can occur. Careful follow-up of individuals at higher risk of uterine perforation is warranted. FUNDING Bayer AG.
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Affiliation(s)
- Susan D Reed
- Department of Obstetrics & Gynecology, University of Washington, Seattle, WA, USA.
| | - Xiaolei Zhou
- RTI Health Solutions, Research Triangle Park, NC, USA
| | - Laura Ichikawa
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | | | - Jeffrey F Peipert
- Department of Obstetrics and Gynecology, Indiana University, Indianapolis, IN, USA
| | - Mary Anne Armstrong
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Tina Raine-Bennett
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA; Department of Health Systems Science at the Kaiser Permanente, Bernard J Tyson School of Medicine, Pasadena, CA, USA
| | - Darios Getahun
- Department of Health Systems Science at the Kaiser Permanente, Bernard J Tyson School of Medicine, Pasadena, CA, USA; Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Michael J Fassett
- Department of Obstetrics & Gynecology, Kaiser Permanente West Los Angeles Medical Center, Los Angeles, CA, USA
| | | | - Jiaxiao M Shi
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
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28
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Roque CL, Morello LE, Arora KS. Postpartum Contraceptive Decision-Making of Parous Teens-A Qualitative Study. J Pediatr Adolesc Gynecol 2022; 35:329-335. [PMID: 34742936 PMCID: PMC9396354 DOI: 10.1016/j.jpag.2021.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 10/05/2021] [Accepted: 10/18/2021] [Indexed: 10/19/2022]
Abstract
STUDY OBJECTIVE Approximately 25% of teens in the United States will become pregnant before the age of 18, and within 2 years, more than 31% will have a repeat pregnancy. Acknowledging that some adolescents might seek or be ambivalent toward rapid repeat pregnancy, compared with their counterparts, not using a long-acting reversible contraception method increases a teen's risk of another pregnancy in 2 years by more than 35 times. We seek to better understand the influences and factors surrounding adolescent postpartum contraceptive decision-making following the index delivery. DESIGN We completed a qualitative study via focused, semistructured interviews during an inpatient postpartum course. The interview guide was modeled after those used in other studies of adolescent contraceptive decision-making, beta tested, and developed iteratively. Interviews were completed, transcribed, coded, and analyzed with the assistance of Dedoose. SETTING The study was conducted at MetroHealth Medical Center in Cleveland, Ohio. PARTICIPANTS Parous adolescents aged 13-19 RESULTS: We performed 12 interviews prior to reaching theoretical saturation. Themes were identified related to the participants' prior experiences with contraception and prior and current pregnancies. The participants' contraceptive choices were influenced by personal relationships, varying levels of autonomy, misperceptions, and changing contraceptive needs. CONCLUSIONS We found that adolescents' contraceptive decision-making was influenced by their social networks and community, including their parents and friends. Mothers played a key role as adolescents transitioned to gaining more autonomy over their reproductive decisions. Providers should consistently present adolescents with comprehensive contraceptive options as a component of preventive health care.
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Affiliation(s)
- Charita L Roque
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD.
| | - Laura E Morello
- Department of Bioethics, Case Western Reserve University, Cleveland, Ohio
| | - Kavita S Arora
- Department of Bioethics, Case Western Reserve University, Cleveland, Ohio; Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC
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29
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Taft A, Watson CJ, McCarthy E, Black KI, Lucke J, McGeechan K, Haas M, McNamee K, Peipert JF, Mazza D. Sustainable and effective methods to increase long-acting reversible contraception uptake from the ACCORd general practice trial. Aust N Z J Public Health 2022; 46:540-544. [PMID: 35557481 DOI: 10.1111/1753-6405.13242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 10/01/2021] [Accepted: 02/01/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Most Australian women access contraception through general practitioners (GPs) but choose oral methods rather than long-acting reversible contraceptives (LARCS). The Australian Contraceptive ChOice pRoject (ACCORd) successfully tested a complex intervention for LARC uptake. We aimed to explore the critical elements of this intervention to increase LARC uptake. DESIGN ACCORd was a cluster randomised control trial conducted in 57 GP clinics in Melbourne, Australia. To explore intervention impact, fidelity checks (n=21 GPs) and interviews with 37 GPs and 40 patients were undertaken 12 months after initial consultations. Data were inductively coded, thematically analysed and mapped to Normalization Process Theory constructs. RESULTS Doctors understood the importance of effectiveness-based contraceptive counselling (EBCC). GPs demonstrated cognitive engagement in the promotion of LARC and some appreciated the rapid referral pathways. GPs and women valued the effectiveness approach. GPs held varying views about having a rapid referral pathway, with many already having established pathways in place. Some GPs viewed intrauterine device insertion costs or insertion training as barriers to ongoing practice. Most GPs and women saw the ACCORD model as effective and sustainable. CONCLUSIONS GP training in EBCC and the use of rapid referral pathways were critical features of an effective sustainable model for successful uptake of LARCs in primary care. IMPLICATIONS FOR PUBLIC HEALTH Improving Australian women's access to and use of LARCs is sustainable with EBCC training and support for general practitioners.
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Affiliation(s)
- Angela Taft
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Victoria
| | - Cathy J Watson
- Department of General Practice, School of Primary and Allied Health Care, Monash University, Victoria
| | - Edwina McCarthy
- Department of General Practice, School of Primary and Allied Health Care, Monash University, Victoria
| | - Kirsten I Black
- Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, New South Wales
| | - Jayne Lucke
- School of Psychology and Public Health, La Trobe University, Victoria
| | - Kevin McGeechan
- Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, New South Wales
| | - Marion Haas
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, New South Wales
| | | | - Jeffrey F Peipert
- Department of Obstetrics and Gynecology, School of Medicine, Indiana University, USA
| | - Danielle Mazza
- Department of General Practice, School of Primary and Allied Health Care, Monash University, Victoria
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30
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Sharan S, Choi S, Zou Y, Wang Y, Kim MJ, Fang L, Choi S, Makhlouf F, Grosser SC, Zhang X, Zhao L. Application of Modeling and Simulation to Identify a Shortened Study Duration and Novel Bioequivalence Metric for a Long-Acting Intrauterine System. AAPS J 2022; 24:63. [DOI: 10.1208/s12248-022-00715-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 04/21/2022] [Indexed: 11/30/2022] Open
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31
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Berezin MN, Javdani S, Godfrey E. Predictors of Sexual and Reproductive Health Among Girls Involved in the Juvenile Legal System: the Influence of Resources, Race, and Ethnicity. CHILDREN AND YOUTH SERVICES REVIEW 2022; 136:106426. [PMID: 35370335 PMCID: PMC8975126 DOI: 10.1016/j.childyouth.2022.106426] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Girls involved in the juvenile legal system are at among the highest risk for sexual and reproductive health (SRH) challenges. Yet, few studies focus on girls or examine multiple predictors of their SRH in tandem. In addition to individual and familial-level risk factors (e.g., trauma, substance use, parental monitoring), this study also examines the influence of structural disadvantage on girls' SRH by assessing the degree to which girls' self-identified resource needs and access challenges across multiple areas (e.g., housing, employment, healthcare) predict SRH risk. Cross-sectional data collected from 269 girls involved in the legal system and their caregivers were analyzed using hierarchical regression analyses. Findings suggest that, over and above individual and familial level predictors, resource access challenges significantly predict girls' SRH, while high resource needs and access challenges predict Black girls' SRH specifically. Implications for programming, policy, and research are delineated.
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Affiliation(s)
| | - Shabnam Javdani
- New York University, Department of Applied Psychology
- Corresponding Author: 246 Greene Street, New York, NY 10012; ; 212 992 9739
| | - Erin Godfrey
- New York University, Department of Applied Psychology
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32
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Kirubarajan A, Li X, Yau M, Yu C, Got T, Li Q, Huszti E, Leung S, Thangavelu N, Sobel M. Awareness, knowledge, and misconceptions of adolescents and young people regarding long-acting reversible contraceptives: a systematic review and meta-analysis. Fertil Steril 2022; 118:168-179. [DOI: 10.1016/j.fertnstert.2022.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 11/04/2022]
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Livingood WC, Bull KL, Biegner S, Kaunitz AM, Howard L, Jefferson V, Geisselmaier PJ, Michel I, Bilello L. Incorporating Black women’s perspectives into long-acting reversible contraception implementation. F S Rep 2022; 3:80-90. [PMID: 35937447 PMCID: PMC9349241 DOI: 10.1016/j.xfre.2022.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 02/17/2022] [Accepted: 02/18/2022] [Indexed: 11/28/2022] Open
Abstract
Objective To study urban, predominantly Black women’s expressed opinions and beliefs related to the use of contraceptives to better inform implementation strategies designed to increase the use of highly effective contraceptives among minoritized and low-income women. Design Focus group interviews with women, in conjunction with a community-based organization providing programs for underserved women with a mission of improved women and infant health. Setting Focus groups were conducted, and women were recruited from clinical sites in predominantly African American urban neighborhoods in a southeastern US city. Patient(s) Self-identified 18–35-year-old women recruited from clinical sites in the urban core of the city with an 80% African American population. Intervention(s) No interventions tested. Main Outcome Measure(s) Black women’s opinions and concerns about contraception. Results Key insights from the focus group results for healthcare providers include the following: the importance of framing discussions with patients within the context of the patients’ goals; need to acknowledge and respect the support systems that women rely on for child birthing and childcare; recognition of the clinician’s role as a trusted and respected source of information; and need to understand and be prepared to address much of the inaccurate and misleading information that can interfere with the patients’ optimal choices for contraception. Conclusions A critical component for applying the implementation science theory to increase the use of evidence-based practices, such as implementation of highly effective contraceptives, requires understanding women’s perspectives of the factors influencing their decisions to use highly effective contraceptives. This study provides important insights into the following: the potential barriers inherent in minoritized women’s concerns about contraceptives and how these insights can inform implementation strategies such as patient-centered counseling and education to overcome those barriers.
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Association of the Delaware Contraceptive Access Now Initiative with Postpartum LARC Use. Matern Child Health J 2022; 26:1657-1666. [PMID: 35488950 PMCID: PMC9055365 DOI: 10.1007/s10995-022-03433-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2022] [Indexed: 12/03/2022]
Abstract
Objectives Although multi-component policy interventions can be important tools to increase access to contraception, we know little about how they may change contraceptive use among postpartum women. We estimate the association of the Delaware Contraceptive Access Now (DelCAN) initiative with use of postpartum Long-Acting Reversible Contraception (LARC). DelCAN included Medicaid payment reform for immediate postpartum LARC use, provider training and technical assistance in LARC provision, and a public awareness campaign. Methods We used a difference-in-differences design and data from the 2012 to 2017 pregnancy risk assessment monitoring system to compare changes in postpartum LARC use in Delaware versus 15 comparison states, and differences in such changes by women’s Medicaid enrollment. Results Relative to the comparison states, postpartum LARC use in Delaware increased by 5.26 percentage points (95% CI 2.90–7.61, P < 0.001) during the 2015–2017 DelCAN implementation period. This increase was the largest among Medicaid-covered women, and grew over the first three implementation years. By the third year of the DelCAN initiative (2017), the relative increase in postpartum LARC use for Medicaid women exceeded that for non-Medicaid women by 7.24 percentage points (95% CI 0.12–14.37, P = 0.046). Conclusions for Practice The DelCAN initiative was associated with increased LARC use among postpartum women in Delaware. During the first 3 years of the initiative, LARC use increased progressively and to a greater extent among Medicaid-enrolled women. Comprehensive initiatives that combine Medicaid payment reforms, provider training, free contraceptive services, and public awareness efforts may reduce unmet demand for highly effective contraceptives in the postpartum months. Supplementary Information The online version contains supplementary material available at 10.1007/s10995-022-03433-2.
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Mubangizi V, McGrath N, Kabakyenga JK, Muller I, Stuart BL, Raftery JP, Natukunda S, Ngonzi J, Goodhart C, Willcox ML. Antenatal couples' counselling in Uganda (ACCU): study protocol for a randomised controlled feasibility trial. Pilot Feasibility Stud 2022; 8:97. [PMID: 35488317 PMCID: PMC9051788 DOI: 10.1186/s40814-022-01049-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 04/14/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Common avoidable factors leading to maternal, perinatal and neonatal deaths include lack of birth planning (and delivery in an inappropriate place) and unmet need for contraception. Progress has been slow because routine antenatal care has focused only on women. Yet, in Uganda, many women first want the approval of their husbands. The World Health Organization recommends postpartum family planning (PPFP) as a critical component of health care. The aim of this trial is to test the feasibility of recruiting and retaining participants in a trial of a complex community-based intervention to provide counselling to antenatal couples in Uganda. METHODS This is a two-group, non-blinded cluster-randomised controlled feasibility trial of a complex intervention. Primary health centres in Uganda will be randomised to receive the intervention or usual care provided by the Ministry of Health. The intervention consists of training village health teams to provide basic counselling to couples at home, encouraging men to accompany their wives to an antenatal clinic, and secondly of training health workers to provide information and counselling to couples at antenatal clinics, to facilitate shared decision-making on the most appropriate place of delivery, and postpartum contraception. We aim to recruit 2 health centres in each arm, each with 10 village health teams, each of whom will aim to recruit 35 pregnant women (a total of 700 women per arm). The village health teams will follow up and collect data on pregnant women in the community up to 12 months after delivery and will directly enter the data using the COSMOS software on a smartphone. DISCUSSION This intervention addresses two key avoidable factors in maternal, perinatal and neonatal deaths (lack of family planning and inappropriate place of delivery). Determining the acceptability and feasibility of antenatal couples' counselling in this study will inform the design of a fully randomised controlled clinical trial. If this trial demonstrates the feasibility of recruitment and delivery, we will seek funding to conduct a fully powered trial of the complex intervention for improving uptake of birth planning and postpartum family planning in Uganda. TRIAL REGISTRATION Pan African Clinical Trials Registry PACTR202102794681952 . Approved on 10 February 2021. ISRCTN Registry ISRCTN97229911. Registered on 23 September 2021.
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Affiliation(s)
- Vincent Mubangizi
- Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda.
| | - Nuala McGrath
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
- Department of Social Statistics and Demography, Faculty of Social Sciences, University of Southampton, Southampton, UK
| | | | - Ingrid Muller
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Beth L Stuart
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - James P Raftery
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Sylvia Natukunda
- Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Joseph Ngonzi
- Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | | | - Merlin Luke Willcox
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
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Mubangizi V, Plastow J, Nakaggwa F, Nahabwe H, Natukunda S, Atim F, Mawere B, Laughton M, Muller I, Owokuhaisa J, Coates S, Chambers I, Goodhart C, Willcox M. Assessing changes in knowledge, attitudes, and intentions to use family planning after watching documentary and drama health education films: a qualitative study. Reprod Health 2022; 19:65. [PMID: 35279189 PMCID: PMC8917732 DOI: 10.1186/s12978-022-01370-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/01/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND There is a paucity of literature on the effectiveness of drama or documentary films in changing knowledge, beliefs, attitudes, and behavior of people towards family planning. This study aimed to compare and assess the acceptability of health promotion films based on documentary or drama, and their effect on knowledge, attitudes, and intention to use family planning. METHODS We developed short documentary and drama films about contraceptive implants, using the person-based approach. Their acceptability was assessed in focus group discussions with younger women below 23 years, women over 23 years, men of reproductive age, and health workers in four different areas of Uganda (Bwindi/Kanungu, Walukuba/Jinja, Kampala, and Mbarara). Transcripts of the focus group discussions were analyzed using thematic analysis, to generate themes and examine the key issues. We assessed changes in knowledge, attitudes, and intentions to use family planning after watching the films. RESULTS Sixteen focus groups with 150 participants were carried out. Participants said that the documentary improved their knowledge and addressed their fears about side effects, myths, and implant insertion. The drama improved their attitudes towards the implant and encouraged them to discuss family planning with their partner. The final versions of the documentary and the drama films were equally liked. CONCLUSIONS Viewing a short documentary on the contraceptive implant led to positive changes in knowledge, while a short drama improved attitudes and intentions to discuss the implant with their partner. The drama and documentary have complementary features, and most participants wanted to see both.
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Affiliation(s)
- Vincent Mubangizi
- Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda.
| | - Jane Plastow
- School of English, The University of Leeds, Leeds, UK
| | | | | | - Sylvia Natukunda
- Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Fiona Atim
- Clarke International University, Kampala, Uganda
| | | | - Matthew Laughton
- Primary Care Research Centre, School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Ingrid Muller
- Primary Care Research Centre, School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Judith Owokuhaisa
- Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | | | | | | | - Merlin Willcox
- Primary Care Research Centre, School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
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Wilson CH, Lazorwitz A, Hyer J, Guiahi M. Concordance of Desired and Administered Postpartum Contraceptives among Emergency and Full Scope Medicaid Patients. Womens Health Issues 2022; 32:343-351. [PMID: 35272884 DOI: 10.1016/j.whi.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 12/29/2021] [Accepted: 01/27/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine if concordance of contraceptive preference and uptake differ between postpartum recipients of emergency versus full scope Medicaid. STUDY DESIGN We performed a historical cohort study of patients who delivered at a safety-net hospital in Denver, Colorado in 2016. In our public system, all patients had access to immediate postpartum tubal ligation and all forms of reversible contraception in outpatient clinics. We used data from electronic health records to compare contraceptive preferences and uptake between patients with full scope and emergency Medicaid at hospital discharge and by 12 weeks postpartum. We then compared contraceptive concordance (use of the same method as desired during delivery admission) between the groups at time of postpartum discharge and by 12 weeks postpartum. RESULTS We examined 693 women; 349 (50.1%) had emergency Medicaid and 344 (49.9%) had full scope Medicaid. The mean age at delivery was 27.9 years, and most patients were Hispanic (74%). Women with emergency Medicaid were less likely to receive their desired method of postpartum contraception before hospital discharge (53.6% vs. 66.9%; p < .01). One-half of the patients with emergency Medicaid who did not receive their desired method of immediate postpartum contraception were unable to obtain it based on insurance ineligibility. By 12 weeks postpartum, the rates of concordance did not differ by insurance status: 52.4% of patients with emergency Medicaid and 55.2% of patients with full scope Medicaid received their desired method of contraception (p = .46). CONCLUSIONS Emergency Medicaid recipients, largely recent and/or unauthorized immigrants, have high demand for highly effective postpartum contraceptives. Although emergency Medicaid recipients initially had lower rates of receipt of their desired contraceptive during the hospital stay compared with those with full scope Medicaid, they ultimately had similar concordance rates by 12 weeks postpartum. We suspect this finding was in part due to free access to all methods of contraception in our outpatient clinics during the postpartum course. Systemic barriers should be reduced to ensure better access to postpartum contraceptives for all patients, regardless of insurance coverage, to improve reproductive equity.
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Affiliation(s)
- Carrie H Wilson
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado.
| | - Aaron Lazorwitz
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado
| | - Jennifer Hyer
- Department of Obstetrics and Gynecology, Denver Health Medical Center, Denver, Colorado
| | - Maryam Guiahi
- Planned Parenthood California Central Coast, Santa Barbara, California
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Schiavoni KH, Lawrence J, Xue J, Kotelchuck M, Boudreau AA. Pediatric Practice Transformation and Long-Acting Reversible Contraception (LARC) Use in Adolescents. Acad Pediatr 2022; 22:296-304. [PMID: 34758402 DOI: 10.1016/j.acap.2021.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 10/27/2021] [Accepted: 10/31/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Long acting reversible contraceptives (LARCs) are recommended as highly effective for adolescents. Although the uptake of LARCs has increased, overall use remains low due to barriers for both providers and patients. We evaluate whether pediatric medical home transformation, including implant placement in pediatrics, may increase LARC use or decrease adolescent pregnancy rates. METHODS Retrospective interrupted time-series analysis of adolescents ages 11 to 19 years at 2 pediatric practices in academically affiliated community health centers during 2005-2015. The intervention practice underwent medical home transformation including team-based care with family planning and health coaching, youth-friendly policies, and contraceptive implant placement. The control practice continued usual care. Differential changes in population event rates were evaluated using a segmented longitudinal regression model. RESULTS The study population included 4946 adolescent females at the intervention practice and 1992 at the control practice. Following practice transformation, LARC use increased significantly more at the intervention practice compared to the control (1.73 versus 0.28 events per 1000 patients quarterly P = 0.004). Pregnancy rate declined at both practices without temporal correlation to the LARC intervention. During the medical home transformation period, the intervention practice showed a greater decline in pregnancy rate, though this difference did not reach statistical significance (2.01 versus 0.81 events per 1000 patients quarterly P = 0.090). CONCLUSIONS Adolescents had higher LARC use where implant placement was offered within the pediatric practice as part of medical home transformation. Although LARC did not impact pregnancy rate, the process of practice transformation may have accelerated its decline through heightened adolescent health focus.
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Affiliation(s)
- Katherine H Schiavoni
- Massachusetts General Hospital, Department of Pediatrics (KH Schiavoni, J Xue, M Kotelchuck, and AA Boudreau), Boston, Mass; Mass General Brigham, Population Health Management (KH Schiavoni), Somerville, Mass; Harvard Medical School (KH Schiavoni, J Xue, M Kotelchuck, and AA Boudreau), Boston, Mass.
| | - Jourdyn Lawrence
- Harvard T. H. Chan School of Public Heath, Department of Social and Behavioral Sciences (J Lawrence), Boston, Mass
| | - Jiayin Xue
- Massachusetts General Hospital, Department of Pediatrics (KH Schiavoni, J Xue, M Kotelchuck, and AA Boudreau), Boston, Mass; Harvard Medical School (KH Schiavoni, J Xue, M Kotelchuck, and AA Boudreau), Boston, Mass
| | - Milton Kotelchuck
- Massachusetts General Hospital, Department of Pediatrics (KH Schiavoni, J Xue, M Kotelchuck, and AA Boudreau), Boston, Mass; Harvard Medical School (KH Schiavoni, J Xue, M Kotelchuck, and AA Boudreau), Boston, Mass
| | - Alexy Arauz Boudreau
- Massachusetts General Hospital, Department of Pediatrics (KH Schiavoni, J Xue, M Kotelchuck, and AA Boudreau), Boston, Mass; Harvard Medical School (KH Schiavoni, J Xue, M Kotelchuck, and AA Boudreau), Boston, Mass
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Contraception and Reproductive Health Care for Adolescent and Young Adult Women with Epilepsy. J Pediatr 2022; 241:229-236. [PMID: 34728232 DOI: 10.1016/j.jpeds.2021.10.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/16/2021] [Accepted: 10/27/2021] [Indexed: 11/21/2022]
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Brittain AW, Steiner RJ, Fasula AM, Hatfield-Timajchy K, Kulkarni A, Koumans EH. Improving Access to and Quality of Sexual and Reproductive Health Services for Adolescents in the United States. J Womens Health (Larchmt) 2022; 31:7-12. [PMID: 35023768 PMCID: PMC10961097 DOI: 10.1089/jwh.2021.0610] [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: 11/12/2022] Open
Abstract
Equitable access to high quality adolescent sexual and reproductive health (ASRH) services can help reduce unintended pregnancies, sexually transmitted diseases, and disparities in these outcomes. The Centers for Disease Control and Prevention (CDC), Division of Reproductive Health, has a long history of working to improve access to and quality of ASRH services through applied research and public health practice. This report from CDC summarizes the evolution of these efforts from more than a decade of work-from community-based demonstration projects to an initiative to support wide-scale implementation. We describe a community-wide teen pregnancy prevention program model that includes a component addressing ASRH services (2010-2015), focused efforts related to quality improvement (QI) of and community-clinic linkages to ASRH services (2015-2020), and the development of a QI package that collates implementation strategies and tools to improve ASRH services (2020-2022). We conclude by discussing future directions. In disseminating key strategies and resources from this work, we aim to support broader public health and clinical efforts to strengthen ASRH care in the United States in ways that promote health equity.
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Affiliation(s)
- Anna W Brittain
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Riley J Steiner
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amy M Fasula
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kendra Hatfield-Timajchy
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Aniket Kulkarni
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Emilia H Koumans
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Lewandowska M, De Abreu Lourenco R, Haas M, Watson CJ, Black KI, Taft A, Lucke J, McGeechan K, McNamee K, Peipert JF, Mazza D. Cost-effectiveness of a complex intervention in general practice to increase uptake of long-acting reversible contraceptives in Australia. AUST HEALTH REV 2021; 45:728-734. [PMID: 34903325 DOI: 10.1071/ah20282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 03/09/2021] [Indexed: 11/23/2022]
Abstract
Objective The aim of this study was to evaluate the cost-effectiveness of the Australian Contraceptive ChOice pRoject (ACCORd) intervention. Methods An economic evaluation compared the costs and outcomes of the ACCORd intervention with usual care (UC). Data from the ACCORd trial were used to estimate costs and efficacy in terms of contraceptive uptake and quality of life. Rates of contraceptive failure and pregnancy were sourced from the literature. Using a Markov model, within-trial results were extrapolated over 10 years and subjected to univariate sensitivity analyses. Model outputs were expressed as the cost per quality-adjusted life years (QALY) gained and cost per unintended pregnancy resulting in birth (UPB) avoided. Results Over 10 years, compared with UC, initiating contraception through the ACCORd intervention resulted in 0.02 fewer UPB and higher total costs (A$2505 vs A$1179) per woman. The incremental cost-effectiveness of the ACCORd intervention versus UC was A$1172 per QALY gained and A$7385 per UPB averted. If the start-up cost of the ACCORd intervention was removed, the incremental cost-effectiveness ratio was A$81 per QALY gained and A$511 per UPB averted. The results were most sensitive to the probability of contraceptive failure, the probability of pregnancy-related healthcare service utilisation or the inclusion of the costs of implementing the ACCORd intervention. Conclusions From a health system perspective, if implemented appropriately in terms of uptake and reach, and assuming an implicit willingness to pay threshold of A$50 000 the ACCORd intervention is cost-effective. What is known about the topic? The uptake of long-active reversible contraceptives (LARC) in Australia is low. The ACCORd trial assessed the efficacy of providing structured training to general practitioners (GPs) on LARC counselling, together with access to rapid referral to insertion clinics. What does this paper add? This study is the first to assess the cost-effectiveness of a complex intervention in the general practice setting aimed at increasing the uptake of LARC in Australia. What are the implications for practitioners? The results show that implementing a complex intervention in general practice involving GP education and the availability of rapid referral to LARC insertion clinics is a cost-effective approach to increase LARC use and its attending efficacy. If the majority of Australian GPs were able to deliver effectiveness-based contraceptive counselling and either insert LARC or use a rapid referral process to a LARC insertion clinic, the additional cost associated with the purchase of LARC products and their insertion would be offset by reductions to health system costs as a result of fewer UPB and abortions. Moreover, the benefits to women's physical and psychological health of avoiding such events is substantial.
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Affiliation(s)
- Milena Lewandowska
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, NSW, Australia. ; ; and Corresponding author.
| | - Richard De Abreu Lourenco
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, NSW, Australia. ;
| | - Marion Haas
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, NSW, Australia. ; ; and School of Public Health, University of Sydney, NSW, Australia.
| | - Cathy J Watson
- Department of General Practice, Monash University, Melbourne, Vic., Australia. ;
| | - Kirsten I Black
- Royal Prince Alfred Hospital, University of Sydney, NSW, Australia.
| | - Angela Taft
- Judith Lumley Centre, La Trobe University, Melbourne, Vic., Australia.
| | - Jayne Lucke
- School of Psychology and Public Health, La Trobe University, Melbourne, Vic., Australia.
| | - Kevin McGeechan
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, NSW, Australia. ; ; and School of Public Health, University of Sydney, NSW, Australia.
| | - Kathleen McNamee
- Family Planning Victoria, Vic., Australia. ; and Obstetrics and Gynaecology, Monash Health, Monash University, Melbourne, Vic., Australia
| | - Jeffrey F Peipert
- Department of Obstetrics and Gynaecology, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Danielle Mazza
- Department of General Practice, Monash University, Melbourne, Vic., Australia. ;
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Rosenthal MA, McQuillan SK. What do I need to know about the etonogestrel-relesasing contraceptive implant (Nexplanon)? Paediatr Child Health 2021; 26:394-395. [PMID: 34777656 DOI: 10.1093/pch/pxab014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/03/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Margot A Rosenthal
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sarah K McQuillan
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada
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Steiner RJ, Pampati S, Kortsmit KM, Liddon N, Swartzendruber A, Pazol K. Long-Acting Reversible Contraception, Condom Use, and Sexually Transmitted Infections: A Systematic Review and Meta-analysis. Am J Prev Med 2021; 61:750-760. [PMID: 34686301 PMCID: PMC9125421 DOI: 10.1016/j.amepre.2021.04.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 04/14/2021] [Accepted: 04/21/2021] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Given mixed findings regarding the relationship between long-acting reversible contraception and condom use, this systematic review and meta-analysis synthesizes studies comparing sexually transmitted infection‒related outcomes between users of long-acting reversible contraception (intrauterine devices, implants) and users of moderately effective contraceptive methods (oral contraceptives, injectables, patches, rings). METHODS MEDLINE, Embase, PsycINFO, Global Health, CINAHL, Cochrane Library, and Scopus were searched for articles published between January 1990 and July 2018. Eligible studies included those that (1) were published in the English language, (2) were published in a peer-reviewed journal, (3) reported empirical, quantitative analyses, and (4) compared at least 1 outcome of interest (condom use, sexual behaviors other than condom use, sexually transmitted infection‒related service receipt, or sexually transmitted infections/HIV) between users of long-acting reversible contraception and users of moderately effective methods. In 2020, pooled ORs were calculated for condom use, chlamydia/gonorrhea infection, and trichomoniasis infection; findings for other outcomes were synthesized qualitatively. The protocol is registered on the International Prospective Register of Systematic Reviews (CRD42018109489). RESULTS A total of 33 studies were included. Long-acting reversible contraception users had decreased odds of using condoms compared with oral contraceptive users (OR=0.43, 95% CI=0.30, 0.63) and injectable, patch, or ring users (OR=0.58, 95% CI=0.48, 0.71); this association remained when limited to adolescents and young adults only. Findings related to multiple sex partners were mixed, and only 2 studies examined sexually transmitted infection testing, reporting mainly null findings. Pooled estimates for chlamydia and/or gonorrhea were null, but long-acting reversible contraception users had increased odds of trichomoniasis infection compared with oral contraceptive users (OR=2.01, 95% CI=1.11, 3.62). DISCUSSION Promoting condom use specifically for sexually transmitted infection prevention may be particularly important among long-acting reversible contraception users at risk for sexually transmitted infections, including adolescents and young adults.
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Affiliation(s)
- Riley J Steiner
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Sanjana Pampati
- Oak Ridge Institute for Science and Education, Atlanta, Georgia
| | - Katherine M Kortsmit
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nicole Liddon
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Andrea Swartzendruber
- Department of Epidemiology & Biostatistics, University of Georgia College of Public Health, Athens, Georgia
| | - Karen Pazol
- Division of Human Development and Disability, Centers for Disease Control and Prevention, Atlanta, Georgia
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Abstract
The request for a contraception in adolescent women makes it possible to address HPV vaccination and prevention of STIs and to search for abuse. Optimizing the use of contraception is the priority. Any contraceptive methods can be offered. Adhesion is improved by prior information and individualized counselling. Apart from the vascular risk associated with the combined hormonal contraception, hormonal contraception provides gynecologic benefits. The efficacy of long-acting methods is higher compared to short-acting methods but their tolerance is a sensitive matter. Emergency contraception can be prescribed in advance. There are measures to facilitate the delivery to minors.
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Affiliation(s)
- Lise Duranteau
- Unité de gynécologie adolescente et jeune adulte, AP-HP, université Paris Saclay (Bicêtre), Hôpital Bicêtre, 78 rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France
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Wilkinson TA, Meredith AH, Rafie S, Katz AJ, Vielott TL, Meagher CG, Ott MA. Adolescents' and Young Adults' Ability to Self-Screen for Contraindications to Hormonal Contraception and the Role of Chronic Illness. J Adolesc Health 2021; 69:566-573. [PMID: 34092474 PMCID: PMC9132612 DOI: 10.1016/j.jadohealth.2021.04.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 04/28/2021] [Accepted: 04/28/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Multiple states allow pharmacists to prescribe hormonal contraception but can have age restrictions. The study objective was to examine how age influences adolescents' and young adults' (AYAs) ability to self-report potential contraindications to hormonal contraception compared with physician reports (our "gold standard"). METHODS Between February 2017 and August 2018, girls aged 14-21 years and their physicians were recruited in outpatient adolescent primary and subspecialty care clinics. Screeners were completed separately for medical conditions that are potential contraindications to hormonal contraception as defined by the Centers for Disease Control Medical Eligibility Criteria. Overall, discordance was defined as differences between the patient's and provider's answers, and potential unsafe discordance was defined as AYAs underreporting of contraindications. Multivariable logistic regression was used to examine predictors of overall and unsafe discordance. RESULTS Of 394 AYA/physician pairs, 45% were from subspecialty clinics, 35% identified as African American, the mean age was 16.7 ± 1.9 years, and 38% were sexually active. Fifty percent of patients reported potential contraindications to hormonal contraception. There was only an 18% rate of unsafe discordance, with no statistical difference by age but a higher rate in subspecialty clinics (28% vs. 10%). No variables were predictive of higher rates of unsafe discordance in general or subspecialty clinics. CONCLUSIONS Potential overall and unsafe discordance between AYAs' and physicians' reports of medical contraindications to combined hormonal contraception were not related to younger age and thus support expansion of pharmacy access to adolescents. Pediatric subspecialists need to proactively address hormonal contraceptive needs and safety as pharmacy access expands.
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Affiliation(s)
- Tracey A Wilkinson
- Indiana University School of Medicine, Department of Pediatrics/Children's Health Services Research, Indianapolis, Indiana.
| | - Ashley H Meredith
- Purdue University College of Pharmacy, Department of Pharmacy Practice, Indianapolis, Indiana
| | - Sally Rafie
- Birth Control Pharmacist, San Diego, California
| | - Amy J Katz
- Indiana University School of Medicine, Department of Pediatrics/Children's Health Services Research, Indianapolis, Indiana
| | - Thomas L Vielott
- Indiana University School of Medicine, Department of Pediatrics/Adolescent Medicine, Indianapolis, Indiana
| | - Carolyn G Meagher
- Indiana University School of Medicine, Department of Pediatrics/Adolescent Medicine, Indianapolis, Indiana
| | - Mary A Ott
- Indiana University School of Medicine, Department of Pediatrics/Adolescent Medicine, Indianapolis, Indiana
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Meredith AH, Wilkinson TA, Campi JA, Meagher CG, Ott MA. Use of the Delphi Method to Enhance Pharmacist Contraceptive Counseling Materials. J Pharm Pract 2021; 34:678-684. [PMID: 31868076 PMCID: PMC7343521 DOI: 10.1177/0897190019894146] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Many states have pharmacist contraceptive prescribing laws with several others in the process of enacting similar legislation. Little continuity or standardization exists across these programs, including development of counseling materials. Although the risk of unplanned pregnancy is greatest among adolescents and young adults, developed materials are not always sensitive to youth. OBJECTIVE To use a modified Delphi method to develop standardized youth-friendly counseling tools that are sensitive to pharmacy workflow during pharmacist contraceptive prescribing. METHODS A multidisciplinary expert panel of women's health pharmacists, community pharmacists, adolescent medicine pediatricians, obstetrician-gynecologists, and public health advocates was assembled and reviewed materials over 3 iterations. Comments were anonymized, summarized, and addressed with each iteration. A graphic designer assisted with visual representation of panel suggestions. Reviewer feedback was qualitatively analyzed for emergent themes. RESULTS The Delphi method produced 5 main themes of feedback integrated into the final materials including attention to work flow, visual appeal, digestible medical information, universal use of materials, and incorporating new evidence-based best practices. Final materials were scored at a Flesch-Kincaid grade of 5.1 for readability. CONCLUSIONS The use of the Delphi method allowed for the efficient production of materials that are medically accurate, patient-centered, and reflect multiple disciplinary perspectives. Final materials were more robust and sensitive to the unique needs of youth.
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Affiliation(s)
- Ashley H. Meredith
- Purdue University College of Pharmacy, Department of Pharmacy Practice, Indianapolis, USA
| | - Tracey A. Wilkinson
- Indiana University School of Medicine, Department of Pediatrics – Health Services Research, Indianapolis, USA
| | - Jennifer A. Campi
- Purdue University College of Pharmacy, Department of Pharmacy Practice, Indianapolis, USA
| | - Carolyn G. Meagher
- Indiana University School of Medicine, Department of Pediatric – Adolescent Medicine, Indianapolis, USA
| | - Mary A. Ott
- Indiana University School of Medicine, Department of Pediatric – Adolescent Medicine, Indianapolis, USA
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Can LARC Fulfill Its Potential to Reduce U.S. Women’s Unintended Pregnancy Risk? Examining Women’s Contraception and Childbearing in the Year Before Initiating LARC. POPULATION RESEARCH AND POLICY REVIEW 2021. [DOI: 10.1007/s11113-021-09681-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Rosenthal MA, McQuillan SK. Contraception chez les adolescentes. CMAJ 2021; 193:E1475-E1476. [PMID: 34544792 PMCID: PMC8476226 DOI: 10.1503/cmaj.202413-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Margot A Rosenthal
- Département d'obstétrique, de gynécologie et des sciences de la reproduction (Rosenthal), Université du Manitoba, Winnipeg, Man.; Département d'obstétrique et de gynécologie (McQuillan), Université de Calgary, Calgary, Alb.
| | - Sarah K McQuillan
- Département d'obstétrique, de gynécologie et des sciences de la reproduction (Rosenthal), Université du Manitoba, Winnipeg, Man.; Département d'obstétrique et de gynécologie (McQuillan), Université de Calgary, Calgary, Alb
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Are Births More Likely to be Intended Following Use of Long-Acting Reversible Contraceptives? An Analysis of U.S. Births in 2003–2015. POPULATION RESEARCH AND POLICY REVIEW 2021. [DOI: 10.1007/s11113-021-09680-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Affiliation(s)
- Margot A Rosenthal
- Department of Obstetrics, Gynecology and Reproductive Sciences (Rosenthal), University of Manitoba, Winnipeg, Man.; Department of Obstetrics and Gynecology (McQuillan), University of Calgary, Calgary, Alta.
| | - Sarah K McQuillan
- Department of Obstetrics, Gynecology and Reproductive Sciences (Rosenthal), University of Manitoba, Winnipeg, Man.; Department of Obstetrics and Gynecology (McQuillan), University of Calgary, Calgary, Alta
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